voluntary loss costs and assigned risk rates … effective january 1, 2015 the “2014 connecticut...

54
Connecticut Voluntary Loss Cost and Assigned Risk Rate Filing Proposed Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned Risk Rates” (“Filing”) is the copyrighted material of the National Council on Compensation Insurance, Inc. (“NCCI”). The NCCI Filing has been posted solely for the purpose of providing public comments to the Connecticut Department of Insurance. Accordingly, the NCCI Filing may not be used for any commercial purposes, including but not limited to redistribution, reposting, creating derivative works, or copying.

Upload: phungdieu

Post on 26-Apr-2018

219 views

Category:

Documents


5 download

TRANSCRIPT

Page 1: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

Connecticut Voluntary Loss Cost and Assigned Risk Rate Filing Proposed Effective January 1 2015

The ldquo2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned Risk Ratesrdquo (ldquoFilingrdquo) is the copyrighted material of the National Council on Compensation Insurance Inc (ldquoNCCIrdquo) The NCCI Filing has been posted solely for the purpose of providing public comments to the Connecticut Department of Insurance Accordingly the NCCI Filing may not be used for any commercial purposes including but not limited to redistribution reposting creating derivative works or copying

Laura Backus Hall State Relations Executive National Council on Regulatory Services Division Compensation Insurance (P) 802-454-1800 (F) 802-454-1802 Email Laura_Backus_Hallnccicom

September 26 2014

Honorable Thomas Leonardi Insurance Commissioner Connecticut Insurance Department 153 Market Square Hartford CT 06103

Re Connecticut Workers Compensation Voluntary Loss Cost and Assigned Risk Rate Changes - Effective January 1 2015

Dear Commissioner Leonardi

In accordance with the applicable statutes and regulations of the state of Connecticut we are filing for your consideration and approval voluntary loss costs assigned risk rates and rating values

The voluntary loss costs which are proposed to be effective January 1 2015 reflect an overall decrease of 06 from the current voluntary loss costs which became effective January 1 2014

The assigned risk rates also proposed to be effective January 1 2015 reflect an overall decrease of 05 from the current assigned risk rates which became effective January 1 2014 Please note the following in connection with this filing

As a result of Item E-1402 the split point for experience rating was changed from $13500 to $15500 This is the third and final year of the split point transition period In each subsequent loss cost filing the split point will be indexed by the countrywide severity change

As a result of Items R-1408 and R-1409 the retrospective rating plan parameters were updated As a result of Item B-1426 the Per Passenger Seat Surcharge for Class Code 7421 is discontinued

effective January 1 2015 As a result of Item B-1427 Class Code 3069 is discontinued effective January 1 2015 and Class

Code 3076 reflects the combined experience of Class Codes 3069 and 3076 As a result of Item B-1422 effective January 1 2012 the payroll determination amounts for

Class Codes 9178 and 9179 are calculated based on the state average weekly wage and therefore multiple Expected Loss Rates are reflected for these codes

As a result of Item 01-CT-2011 effective January 1 2012 the Maximum Payroll for Executive Officers reflected on the Miscellaneous Values page is calculated to reflect the final phase of a transition program using the state average weekly wage The Maximum Payroll for Executive Officers will now be equal to twice the state average weekly wage

1493 Maple Hill Road Plainfield VT 05667 wwwnccicom

TThe Honorable TThomas Leonarddi PPage 2 Juuly 18 2014

This filingg is made excclusively on bbehalf of the companies tthat have givven valid con sideration foor the express ppurpose of fuulfilling regulaatory rate orr pure premiuum filing req uirements annd other privvate use of this infformation

In the encclosed appenndix is a list oof companiess sorted by ggroup whichh as of the timme this filing is submitted are eligiblee to referencce this informmation The inclusion of aa company on this list meerely indicates that the commpany or thee group to wwhich it belonngs is affiliateed with NCC I in this statee or has licensed tthis informattion as a non -affiliate andd is not intennded to indiccate whetherr the companny is currently writing business or is ev en licensed tto write businness in this sstate

Please coontact me at 802-454-18000 or Jim Davvis at 561-8993-3097 if yo u have any qquestions or need any further innformation

Respectfuully submitteed

Laura Bacckus Hall State Relaations Executive

__________________________

Coonnecticut

WORRKERS COMPENSATTION FILINGG ndash JANUAARY 1 20115

Actuarial Certificattion

I James R Davis amm a Directorr and Actuarry for the National Counccil on Comp ensation Insurance Inc I am an Associate of the Cassualty Actuarrial Society aand a membber of the Americann Academy oof Actuaries and I meett the Qualificcation Stand ards of the AAmerican Academyy of Actuariees to providee the actuariaal report conntained hereein

The inforrmation conttained in thiss report has been preparred under mmy direction in accordancce with appllicable Actuaarial Standarrds of Practice as promuulgated by thhe Actuarial Standards Board TThe Actuariaal Standards Board is veested by the US-based actuarial orgganizations with the respoonsibility for promulgatinng Actuarial SStandards oof Practice foor actuaries providing professioonal servicess in the Uniteed States EEach of thesse organizatiions requiress its membeers through its Code of PProfessional Conduct too observe thee Actuarial SStandards off Practice when practicingg in the United States

James RR Davis ACAAS MAAA Director aand Actuaryy Actuarial and Econommic Servicess

copy Copyright 2014 National CCouncil on Comppensation Insurannce Inc All Righhts Reserved

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

These materials are comprised of NCCI actuarial judgment and proprietary and confidential information which are valuable assets of NCCI and are protected by copyright and other intellectual property laws The uses of these materials are governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between NCCI and an end user Unless expressly authorized by NCCI you may not copy create derivative works (by way of example create or supplement your own works or other materials) display perform or use the materials in whole or in part in any media Such actions taken by you or by your direction may be in violation of federal copyright and other commercial laws NCCI does not permit or agree to such use of its materials In the event such use is contemplated or desired please contact NCCIs Legal Department for permission

NCCI MAKES NO REPRESENTATIONS OR WARRANTIES RELATING TO THESE MATERIALS INCLUDING ANY EXPRESS STATUTORY OR IMPLIED W ARRANTIES INCLUDING THE IMPLIED WARRANTY OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ADDITIONALLY AUTHORIZED END USERS ASSUME RESPONSIBILITY FOR THE USE OF AND FOR ANY AND ALL RESULTS DERIVED OR OBTAINED THROUGH THE USE OF SUCH MATERIALS

Background and Filing Procedure 1

Proposed Changes in Voluntary Loss Costs and Assigned Risk Rates 2

Key Components Experience 3

Trend 4

Benefits 12

Loss-based Expenses 13

Assigned Risk Market 14

Conclusion 17

Exhibits Exhibit I - Connecticut Historical Loss Cost and Assigned Risk Rate Level Changes 18

Exhibit II - Connecticut Written Premium 19

Exhibit III - Connecticut Largest Workers Compensation Writers CY 2013 20

Exhibit IV - Proposed Voluntary Market Loss Costs and Rating Values 21

Exhibit V - Proposed Assigned Risk Rates and Rating Values 32

NCCI Key Contacts 40

Affiliate List 41

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Table of Contents

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Background and Filing Procedure

The workers compensation benefit system is designed to cover medical costs associated with workplace injuries as well as provide wage replacement (indemnity) benefits to injured workers for lost work time

The National Council on Compensation Insurance Inc (NCCI) collects an extensive amount of information regarding the workers compensation system in Connecticut and submits proposed advisory prospective loss costs (for the voluntary market) and rates (for the assigned risk market) for review and approval by the Connecticut Insurance Commissioner

The advisory prospective loss costs are intended to cover the indemnity and medical benefits provided under the system as well as some of the expenses associated with providing these benefits (loss adjustment expenses) The assigned risk rates additionally contemplate other costs associated with providing workers compensation insurance (such as commissions taxes etc)

Each insurance company offering workers compensation insurance in Connecticut must file a loss cost multiplier to be applied to the approved advisory prospective loss costs in order to compute the final workers compensation rates they intend to charge This multiplier is intended to cover the other costs associated with providing workers compensation insurance that are not already part of the advisory prospective loss costs

In this filing NCCI is proposing that the Connecticut Insurance Department approve a -06 change to the current voluntary loss costs (which went into effect on 112014) and that the new loss costs take effect on 112015 This document will explain why this change is necessary

Employers unable to secure coverage in the voluntary market can apply for such coverage in the assigned risk market In this filing NCCI is also proposing that the Connecticut Insurance Department approve a -05 change to the current assigned risk rate level (which went into effect on 112014) and that the new rates take effect on 112015

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

1

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Proposed Overall Average Change in Voluntary Loss Cost Level

Key Component Percentage Change

Experience and Trend -04 Benefits -02 Loss-based Expenses 00

Overall Loss Cost Level Change Requested -06

The change in loss costs varies depending on the classification Each classification belongs to one of five industry groups The average voluntary loss cost level change proposed for each of these five groups is displayed below as well as the largest increase and largest decrease possible for a classification in each of those groups

OVERALL AVERAGE LOSS COST LEVEL CHANGE

-06

GOODS amp SERVICES +06

Maximum Increase +21 Maximum Decrease -19

MANUFACTURING -05

Maximum Increase +20 Maximum Decrease -20

CONTRACTING -05

Maximum Increase +20 Maximum Decrease -20

MISCELLANEOUS -14

Maximum Increase +19 Maximum Decrease -21

OFFICE amp CLERICAL -32

Maximum Increase +17 Maximum Decrease -23

Proposed Overall Average Change in Assigned Risk Rate Level

Key Component Percentage Change

Overall Voluntary Loss Cost Level Change -06 Change in Assigned Risk Multiplier +01

Overall Rate Level Change Requested -05

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

2

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components

There are four key components in this filing experience trend benefits and expenses They will each be separately discussed

Experience

NCCI analyzed the emerging experience of Connecticut workers compensation policies in recent years The primary focus of our analysis was on premiums and losses from policy years 2011 and 2012 evaluated as of December 31 2013 (a policy year captures the premiums and losses from the block of policies that had effective dates during a given year) The most recently available full policy year is 2012 since the last policy had an effective date of December 31 2012 and did not expire until December 31 2013 The use of the two most recently available full policy years of data is most appropriate in providing balance between stability and responsiveness

It should be noted that NCCI adjusts (via premium and loss on-level factors) the historical policy year experience to reflect approved loss cost and rate level changes as well as statutory benefit level changes implemented since that time period NCCIs standard methodology is to utilize statewide (combined voluntary and assigned risk) market data after it has been adjusted to the current voluntary pure premium level in the calculation of the overall average loss cost level change

Different aggregations of limited loss experience were analyzed in preparation of this filing These were (i) paid losses (benefit amounts already paid by insurers on reported claims) and (ii) the sum of paid losses plus case reserves (paid losses and the amounts set aside to cover future payments on those claims) For use in this filing NCCI utilized loss development factors based on an average of each of these two loss aggregations This is consistent with NCCI filings made in the past several years in Connecticut Loss development factors are needed since paid losses and case reserve estimates on a given claim change over time until the claim is finally closed The loss development factors are based on how paid losses and case reserve estimates changed over time for Connecticut claims from older years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

3

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 2: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

Laura Backus Hall State Relations Executive National Council on Regulatory Services Division Compensation Insurance (P) 802-454-1800 (F) 802-454-1802 Email Laura_Backus_Hallnccicom

September 26 2014

Honorable Thomas Leonardi Insurance Commissioner Connecticut Insurance Department 153 Market Square Hartford CT 06103

Re Connecticut Workers Compensation Voluntary Loss Cost and Assigned Risk Rate Changes - Effective January 1 2015

Dear Commissioner Leonardi

In accordance with the applicable statutes and regulations of the state of Connecticut we are filing for your consideration and approval voluntary loss costs assigned risk rates and rating values

The voluntary loss costs which are proposed to be effective January 1 2015 reflect an overall decrease of 06 from the current voluntary loss costs which became effective January 1 2014

The assigned risk rates also proposed to be effective January 1 2015 reflect an overall decrease of 05 from the current assigned risk rates which became effective January 1 2014 Please note the following in connection with this filing

As a result of Item E-1402 the split point for experience rating was changed from $13500 to $15500 This is the third and final year of the split point transition period In each subsequent loss cost filing the split point will be indexed by the countrywide severity change

As a result of Items R-1408 and R-1409 the retrospective rating plan parameters were updated As a result of Item B-1426 the Per Passenger Seat Surcharge for Class Code 7421 is discontinued

effective January 1 2015 As a result of Item B-1427 Class Code 3069 is discontinued effective January 1 2015 and Class

Code 3076 reflects the combined experience of Class Codes 3069 and 3076 As a result of Item B-1422 effective January 1 2012 the payroll determination amounts for

Class Codes 9178 and 9179 are calculated based on the state average weekly wage and therefore multiple Expected Loss Rates are reflected for these codes

As a result of Item 01-CT-2011 effective January 1 2012 the Maximum Payroll for Executive Officers reflected on the Miscellaneous Values page is calculated to reflect the final phase of a transition program using the state average weekly wage The Maximum Payroll for Executive Officers will now be equal to twice the state average weekly wage

1493 Maple Hill Road Plainfield VT 05667 wwwnccicom

TThe Honorable TThomas Leonarddi PPage 2 Juuly 18 2014

This filingg is made excclusively on bbehalf of the companies tthat have givven valid con sideration foor the express ppurpose of fuulfilling regulaatory rate orr pure premiuum filing req uirements annd other privvate use of this infformation

In the encclosed appenndix is a list oof companiess sorted by ggroup whichh as of the timme this filing is submitted are eligiblee to referencce this informmation The inclusion of aa company on this list meerely indicates that the commpany or thee group to wwhich it belonngs is affiliateed with NCC I in this statee or has licensed tthis informattion as a non -affiliate andd is not intennded to indiccate whetherr the companny is currently writing business or is ev en licensed tto write businness in this sstate

Please coontact me at 802-454-18000 or Jim Davvis at 561-8993-3097 if yo u have any qquestions or need any further innformation

Respectfuully submitteed

Laura Bacckus Hall State Relaations Executive

__________________________

Coonnecticut

WORRKERS COMPENSATTION FILINGG ndash JANUAARY 1 20115

Actuarial Certificattion

I James R Davis amm a Directorr and Actuarry for the National Counccil on Comp ensation Insurance Inc I am an Associate of the Cassualty Actuarrial Society aand a membber of the Americann Academy oof Actuaries and I meett the Qualificcation Stand ards of the AAmerican Academyy of Actuariees to providee the actuariaal report conntained hereein

The inforrmation conttained in thiss report has been preparred under mmy direction in accordancce with appllicable Actuaarial Standarrds of Practice as promuulgated by thhe Actuarial Standards Board TThe Actuariaal Standards Board is veested by the US-based actuarial orgganizations with the respoonsibility for promulgatinng Actuarial SStandards oof Practice foor actuaries providing professioonal servicess in the Uniteed States EEach of thesse organizatiions requiress its membeers through its Code of PProfessional Conduct too observe thee Actuarial SStandards off Practice when practicingg in the United States

James RR Davis ACAAS MAAA Director aand Actuaryy Actuarial and Econommic Servicess

copy Copyright 2014 National CCouncil on Comppensation Insurannce Inc All Righhts Reserved

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

These materials are comprised of NCCI actuarial judgment and proprietary and confidential information which are valuable assets of NCCI and are protected by copyright and other intellectual property laws The uses of these materials are governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between NCCI and an end user Unless expressly authorized by NCCI you may not copy create derivative works (by way of example create or supplement your own works or other materials) display perform or use the materials in whole or in part in any media Such actions taken by you or by your direction may be in violation of federal copyright and other commercial laws NCCI does not permit or agree to such use of its materials In the event such use is contemplated or desired please contact NCCIs Legal Department for permission

NCCI MAKES NO REPRESENTATIONS OR WARRANTIES RELATING TO THESE MATERIALS INCLUDING ANY EXPRESS STATUTORY OR IMPLIED W ARRANTIES INCLUDING THE IMPLIED WARRANTY OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ADDITIONALLY AUTHORIZED END USERS ASSUME RESPONSIBILITY FOR THE USE OF AND FOR ANY AND ALL RESULTS DERIVED OR OBTAINED THROUGH THE USE OF SUCH MATERIALS

Background and Filing Procedure 1

Proposed Changes in Voluntary Loss Costs and Assigned Risk Rates 2

Key Components Experience 3

Trend 4

Benefits 12

Loss-based Expenses 13

Assigned Risk Market 14

Conclusion 17

Exhibits Exhibit I - Connecticut Historical Loss Cost and Assigned Risk Rate Level Changes 18

Exhibit II - Connecticut Written Premium 19

Exhibit III - Connecticut Largest Workers Compensation Writers CY 2013 20

Exhibit IV - Proposed Voluntary Market Loss Costs and Rating Values 21

Exhibit V - Proposed Assigned Risk Rates and Rating Values 32

NCCI Key Contacts 40

Affiliate List 41

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Table of Contents

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Background and Filing Procedure

The workers compensation benefit system is designed to cover medical costs associated with workplace injuries as well as provide wage replacement (indemnity) benefits to injured workers for lost work time

The National Council on Compensation Insurance Inc (NCCI) collects an extensive amount of information regarding the workers compensation system in Connecticut and submits proposed advisory prospective loss costs (for the voluntary market) and rates (for the assigned risk market) for review and approval by the Connecticut Insurance Commissioner

The advisory prospective loss costs are intended to cover the indemnity and medical benefits provided under the system as well as some of the expenses associated with providing these benefits (loss adjustment expenses) The assigned risk rates additionally contemplate other costs associated with providing workers compensation insurance (such as commissions taxes etc)

Each insurance company offering workers compensation insurance in Connecticut must file a loss cost multiplier to be applied to the approved advisory prospective loss costs in order to compute the final workers compensation rates they intend to charge This multiplier is intended to cover the other costs associated with providing workers compensation insurance that are not already part of the advisory prospective loss costs

In this filing NCCI is proposing that the Connecticut Insurance Department approve a -06 change to the current voluntary loss costs (which went into effect on 112014) and that the new loss costs take effect on 112015 This document will explain why this change is necessary

Employers unable to secure coverage in the voluntary market can apply for such coverage in the assigned risk market In this filing NCCI is also proposing that the Connecticut Insurance Department approve a -05 change to the current assigned risk rate level (which went into effect on 112014) and that the new rates take effect on 112015

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

1

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Proposed Overall Average Change in Voluntary Loss Cost Level

Key Component Percentage Change

Experience and Trend -04 Benefits -02 Loss-based Expenses 00

Overall Loss Cost Level Change Requested -06

The change in loss costs varies depending on the classification Each classification belongs to one of five industry groups The average voluntary loss cost level change proposed for each of these five groups is displayed below as well as the largest increase and largest decrease possible for a classification in each of those groups

OVERALL AVERAGE LOSS COST LEVEL CHANGE

-06

GOODS amp SERVICES +06

Maximum Increase +21 Maximum Decrease -19

MANUFACTURING -05

Maximum Increase +20 Maximum Decrease -20

CONTRACTING -05

Maximum Increase +20 Maximum Decrease -20

MISCELLANEOUS -14

Maximum Increase +19 Maximum Decrease -21

OFFICE amp CLERICAL -32

Maximum Increase +17 Maximum Decrease -23

Proposed Overall Average Change in Assigned Risk Rate Level

Key Component Percentage Change

Overall Voluntary Loss Cost Level Change -06 Change in Assigned Risk Multiplier +01

Overall Rate Level Change Requested -05

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

2

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components

There are four key components in this filing experience trend benefits and expenses They will each be separately discussed

Experience

NCCI analyzed the emerging experience of Connecticut workers compensation policies in recent years The primary focus of our analysis was on premiums and losses from policy years 2011 and 2012 evaluated as of December 31 2013 (a policy year captures the premiums and losses from the block of policies that had effective dates during a given year) The most recently available full policy year is 2012 since the last policy had an effective date of December 31 2012 and did not expire until December 31 2013 The use of the two most recently available full policy years of data is most appropriate in providing balance between stability and responsiveness

It should be noted that NCCI adjusts (via premium and loss on-level factors) the historical policy year experience to reflect approved loss cost and rate level changes as well as statutory benefit level changes implemented since that time period NCCIs standard methodology is to utilize statewide (combined voluntary and assigned risk) market data after it has been adjusted to the current voluntary pure premium level in the calculation of the overall average loss cost level change

Different aggregations of limited loss experience were analyzed in preparation of this filing These were (i) paid losses (benefit amounts already paid by insurers on reported claims) and (ii) the sum of paid losses plus case reserves (paid losses and the amounts set aside to cover future payments on those claims) For use in this filing NCCI utilized loss development factors based on an average of each of these two loss aggregations This is consistent with NCCI filings made in the past several years in Connecticut Loss development factors are needed since paid losses and case reserve estimates on a given claim change over time until the claim is finally closed The loss development factors are based on how paid losses and case reserve estimates changed over time for Connecticut claims from older years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

3

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 3: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

TThe Honorable TThomas Leonarddi PPage 2 Juuly 18 2014

This filingg is made excclusively on bbehalf of the companies tthat have givven valid con sideration foor the express ppurpose of fuulfilling regulaatory rate orr pure premiuum filing req uirements annd other privvate use of this infformation

In the encclosed appenndix is a list oof companiess sorted by ggroup whichh as of the timme this filing is submitted are eligiblee to referencce this informmation The inclusion of aa company on this list meerely indicates that the commpany or thee group to wwhich it belonngs is affiliateed with NCC I in this statee or has licensed tthis informattion as a non -affiliate andd is not intennded to indiccate whetherr the companny is currently writing business or is ev en licensed tto write businness in this sstate

Please coontact me at 802-454-18000 or Jim Davvis at 561-8993-3097 if yo u have any qquestions or need any further innformation

Respectfuully submitteed

Laura Bacckus Hall State Relaations Executive

__________________________

Coonnecticut

WORRKERS COMPENSATTION FILINGG ndash JANUAARY 1 20115

Actuarial Certificattion

I James R Davis amm a Directorr and Actuarry for the National Counccil on Comp ensation Insurance Inc I am an Associate of the Cassualty Actuarrial Society aand a membber of the Americann Academy oof Actuaries and I meett the Qualificcation Stand ards of the AAmerican Academyy of Actuariees to providee the actuariaal report conntained hereein

The inforrmation conttained in thiss report has been preparred under mmy direction in accordancce with appllicable Actuaarial Standarrds of Practice as promuulgated by thhe Actuarial Standards Board TThe Actuariaal Standards Board is veested by the US-based actuarial orgganizations with the respoonsibility for promulgatinng Actuarial SStandards oof Practice foor actuaries providing professioonal servicess in the Uniteed States EEach of thesse organizatiions requiress its membeers through its Code of PProfessional Conduct too observe thee Actuarial SStandards off Practice when practicingg in the United States

James RR Davis ACAAS MAAA Director aand Actuaryy Actuarial and Econommic Servicess

copy Copyright 2014 National CCouncil on Comppensation Insurannce Inc All Righhts Reserved

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

These materials are comprised of NCCI actuarial judgment and proprietary and confidential information which are valuable assets of NCCI and are protected by copyright and other intellectual property laws The uses of these materials are governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between NCCI and an end user Unless expressly authorized by NCCI you may not copy create derivative works (by way of example create or supplement your own works or other materials) display perform or use the materials in whole or in part in any media Such actions taken by you or by your direction may be in violation of federal copyright and other commercial laws NCCI does not permit or agree to such use of its materials In the event such use is contemplated or desired please contact NCCIs Legal Department for permission

NCCI MAKES NO REPRESENTATIONS OR WARRANTIES RELATING TO THESE MATERIALS INCLUDING ANY EXPRESS STATUTORY OR IMPLIED W ARRANTIES INCLUDING THE IMPLIED WARRANTY OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ADDITIONALLY AUTHORIZED END USERS ASSUME RESPONSIBILITY FOR THE USE OF AND FOR ANY AND ALL RESULTS DERIVED OR OBTAINED THROUGH THE USE OF SUCH MATERIALS

Background and Filing Procedure 1

Proposed Changes in Voluntary Loss Costs and Assigned Risk Rates 2

Key Components Experience 3

Trend 4

Benefits 12

Loss-based Expenses 13

Assigned Risk Market 14

Conclusion 17

Exhibits Exhibit I - Connecticut Historical Loss Cost and Assigned Risk Rate Level Changes 18

Exhibit II - Connecticut Written Premium 19

Exhibit III - Connecticut Largest Workers Compensation Writers CY 2013 20

Exhibit IV - Proposed Voluntary Market Loss Costs and Rating Values 21

Exhibit V - Proposed Assigned Risk Rates and Rating Values 32

NCCI Key Contacts 40

Affiliate List 41

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Table of Contents

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Background and Filing Procedure

The workers compensation benefit system is designed to cover medical costs associated with workplace injuries as well as provide wage replacement (indemnity) benefits to injured workers for lost work time

The National Council on Compensation Insurance Inc (NCCI) collects an extensive amount of information regarding the workers compensation system in Connecticut and submits proposed advisory prospective loss costs (for the voluntary market) and rates (for the assigned risk market) for review and approval by the Connecticut Insurance Commissioner

The advisory prospective loss costs are intended to cover the indemnity and medical benefits provided under the system as well as some of the expenses associated with providing these benefits (loss adjustment expenses) The assigned risk rates additionally contemplate other costs associated with providing workers compensation insurance (such as commissions taxes etc)

Each insurance company offering workers compensation insurance in Connecticut must file a loss cost multiplier to be applied to the approved advisory prospective loss costs in order to compute the final workers compensation rates they intend to charge This multiplier is intended to cover the other costs associated with providing workers compensation insurance that are not already part of the advisory prospective loss costs

In this filing NCCI is proposing that the Connecticut Insurance Department approve a -06 change to the current voluntary loss costs (which went into effect on 112014) and that the new loss costs take effect on 112015 This document will explain why this change is necessary

Employers unable to secure coverage in the voluntary market can apply for such coverage in the assigned risk market In this filing NCCI is also proposing that the Connecticut Insurance Department approve a -05 change to the current assigned risk rate level (which went into effect on 112014) and that the new rates take effect on 112015

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

1

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Proposed Overall Average Change in Voluntary Loss Cost Level

Key Component Percentage Change

Experience and Trend -04 Benefits -02 Loss-based Expenses 00

Overall Loss Cost Level Change Requested -06

The change in loss costs varies depending on the classification Each classification belongs to one of five industry groups The average voluntary loss cost level change proposed for each of these five groups is displayed below as well as the largest increase and largest decrease possible for a classification in each of those groups

OVERALL AVERAGE LOSS COST LEVEL CHANGE

-06

GOODS amp SERVICES +06

Maximum Increase +21 Maximum Decrease -19

MANUFACTURING -05

Maximum Increase +20 Maximum Decrease -20

CONTRACTING -05

Maximum Increase +20 Maximum Decrease -20

MISCELLANEOUS -14

Maximum Increase +19 Maximum Decrease -21

OFFICE amp CLERICAL -32

Maximum Increase +17 Maximum Decrease -23

Proposed Overall Average Change in Assigned Risk Rate Level

Key Component Percentage Change

Overall Voluntary Loss Cost Level Change -06 Change in Assigned Risk Multiplier +01

Overall Rate Level Change Requested -05

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

2

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components

There are four key components in this filing experience trend benefits and expenses They will each be separately discussed

Experience

NCCI analyzed the emerging experience of Connecticut workers compensation policies in recent years The primary focus of our analysis was on premiums and losses from policy years 2011 and 2012 evaluated as of December 31 2013 (a policy year captures the premiums and losses from the block of policies that had effective dates during a given year) The most recently available full policy year is 2012 since the last policy had an effective date of December 31 2012 and did not expire until December 31 2013 The use of the two most recently available full policy years of data is most appropriate in providing balance between stability and responsiveness

It should be noted that NCCI adjusts (via premium and loss on-level factors) the historical policy year experience to reflect approved loss cost and rate level changes as well as statutory benefit level changes implemented since that time period NCCIs standard methodology is to utilize statewide (combined voluntary and assigned risk) market data after it has been adjusted to the current voluntary pure premium level in the calculation of the overall average loss cost level change

Different aggregations of limited loss experience were analyzed in preparation of this filing These were (i) paid losses (benefit amounts already paid by insurers on reported claims) and (ii) the sum of paid losses plus case reserves (paid losses and the amounts set aside to cover future payments on those claims) For use in this filing NCCI utilized loss development factors based on an average of each of these two loss aggregations This is consistent with NCCI filings made in the past several years in Connecticut Loss development factors are needed since paid losses and case reserve estimates on a given claim change over time until the claim is finally closed The loss development factors are based on how paid losses and case reserve estimates changed over time for Connecticut claims from older years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

3

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 4: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

__________________________

Coonnecticut

WORRKERS COMPENSATTION FILINGG ndash JANUAARY 1 20115

Actuarial Certificattion

I James R Davis amm a Directorr and Actuarry for the National Counccil on Comp ensation Insurance Inc I am an Associate of the Cassualty Actuarrial Society aand a membber of the Americann Academy oof Actuaries and I meett the Qualificcation Stand ards of the AAmerican Academyy of Actuariees to providee the actuariaal report conntained hereein

The inforrmation conttained in thiss report has been preparred under mmy direction in accordancce with appllicable Actuaarial Standarrds of Practice as promuulgated by thhe Actuarial Standards Board TThe Actuariaal Standards Board is veested by the US-based actuarial orgganizations with the respoonsibility for promulgatinng Actuarial SStandards oof Practice foor actuaries providing professioonal servicess in the Uniteed States EEach of thesse organizatiions requiress its membeers through its Code of PProfessional Conduct too observe thee Actuarial SStandards off Practice when practicingg in the United States

James RR Davis ACAAS MAAA Director aand Actuaryy Actuarial and Econommic Servicess

copy Copyright 2014 National CCouncil on Comppensation Insurannce Inc All Righhts Reserved

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

These materials are comprised of NCCI actuarial judgment and proprietary and confidential information which are valuable assets of NCCI and are protected by copyright and other intellectual property laws The uses of these materials are governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between NCCI and an end user Unless expressly authorized by NCCI you may not copy create derivative works (by way of example create or supplement your own works or other materials) display perform or use the materials in whole or in part in any media Such actions taken by you or by your direction may be in violation of federal copyright and other commercial laws NCCI does not permit or agree to such use of its materials In the event such use is contemplated or desired please contact NCCIs Legal Department for permission

NCCI MAKES NO REPRESENTATIONS OR WARRANTIES RELATING TO THESE MATERIALS INCLUDING ANY EXPRESS STATUTORY OR IMPLIED W ARRANTIES INCLUDING THE IMPLIED WARRANTY OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ADDITIONALLY AUTHORIZED END USERS ASSUME RESPONSIBILITY FOR THE USE OF AND FOR ANY AND ALL RESULTS DERIVED OR OBTAINED THROUGH THE USE OF SUCH MATERIALS

Background and Filing Procedure 1

Proposed Changes in Voluntary Loss Costs and Assigned Risk Rates 2

Key Components Experience 3

Trend 4

Benefits 12

Loss-based Expenses 13

Assigned Risk Market 14

Conclusion 17

Exhibits Exhibit I - Connecticut Historical Loss Cost and Assigned Risk Rate Level Changes 18

Exhibit II - Connecticut Written Premium 19

Exhibit III - Connecticut Largest Workers Compensation Writers CY 2013 20

Exhibit IV - Proposed Voluntary Market Loss Costs and Rating Values 21

Exhibit V - Proposed Assigned Risk Rates and Rating Values 32

NCCI Key Contacts 40

Affiliate List 41

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Table of Contents

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Background and Filing Procedure

The workers compensation benefit system is designed to cover medical costs associated with workplace injuries as well as provide wage replacement (indemnity) benefits to injured workers for lost work time

The National Council on Compensation Insurance Inc (NCCI) collects an extensive amount of information regarding the workers compensation system in Connecticut and submits proposed advisory prospective loss costs (for the voluntary market) and rates (for the assigned risk market) for review and approval by the Connecticut Insurance Commissioner

The advisory prospective loss costs are intended to cover the indemnity and medical benefits provided under the system as well as some of the expenses associated with providing these benefits (loss adjustment expenses) The assigned risk rates additionally contemplate other costs associated with providing workers compensation insurance (such as commissions taxes etc)

Each insurance company offering workers compensation insurance in Connecticut must file a loss cost multiplier to be applied to the approved advisory prospective loss costs in order to compute the final workers compensation rates they intend to charge This multiplier is intended to cover the other costs associated with providing workers compensation insurance that are not already part of the advisory prospective loss costs

In this filing NCCI is proposing that the Connecticut Insurance Department approve a -06 change to the current voluntary loss costs (which went into effect on 112014) and that the new loss costs take effect on 112015 This document will explain why this change is necessary

Employers unable to secure coverage in the voluntary market can apply for such coverage in the assigned risk market In this filing NCCI is also proposing that the Connecticut Insurance Department approve a -05 change to the current assigned risk rate level (which went into effect on 112014) and that the new rates take effect on 112015

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

1

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Proposed Overall Average Change in Voluntary Loss Cost Level

Key Component Percentage Change

Experience and Trend -04 Benefits -02 Loss-based Expenses 00

Overall Loss Cost Level Change Requested -06

The change in loss costs varies depending on the classification Each classification belongs to one of five industry groups The average voluntary loss cost level change proposed for each of these five groups is displayed below as well as the largest increase and largest decrease possible for a classification in each of those groups

OVERALL AVERAGE LOSS COST LEVEL CHANGE

-06

GOODS amp SERVICES +06

Maximum Increase +21 Maximum Decrease -19

MANUFACTURING -05

Maximum Increase +20 Maximum Decrease -20

CONTRACTING -05

Maximum Increase +20 Maximum Decrease -20

MISCELLANEOUS -14

Maximum Increase +19 Maximum Decrease -21

OFFICE amp CLERICAL -32

Maximum Increase +17 Maximum Decrease -23

Proposed Overall Average Change in Assigned Risk Rate Level

Key Component Percentage Change

Overall Voluntary Loss Cost Level Change -06 Change in Assigned Risk Multiplier +01

Overall Rate Level Change Requested -05

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

2

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components

There are four key components in this filing experience trend benefits and expenses They will each be separately discussed

Experience

NCCI analyzed the emerging experience of Connecticut workers compensation policies in recent years The primary focus of our analysis was on premiums and losses from policy years 2011 and 2012 evaluated as of December 31 2013 (a policy year captures the premiums and losses from the block of policies that had effective dates during a given year) The most recently available full policy year is 2012 since the last policy had an effective date of December 31 2012 and did not expire until December 31 2013 The use of the two most recently available full policy years of data is most appropriate in providing balance between stability and responsiveness

It should be noted that NCCI adjusts (via premium and loss on-level factors) the historical policy year experience to reflect approved loss cost and rate level changes as well as statutory benefit level changes implemented since that time period NCCIs standard methodology is to utilize statewide (combined voluntary and assigned risk) market data after it has been adjusted to the current voluntary pure premium level in the calculation of the overall average loss cost level change

Different aggregations of limited loss experience were analyzed in preparation of this filing These were (i) paid losses (benefit amounts already paid by insurers on reported claims) and (ii) the sum of paid losses plus case reserves (paid losses and the amounts set aside to cover future payments on those claims) For use in this filing NCCI utilized loss development factors based on an average of each of these two loss aggregations This is consistent with NCCI filings made in the past several years in Connecticut Loss development factors are needed since paid losses and case reserve estimates on a given claim change over time until the claim is finally closed The loss development factors are based on how paid losses and case reserve estimates changed over time for Connecticut claims from older years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

3

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 5: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

These materials are comprised of NCCI actuarial judgment and proprietary and confidential information which are valuable assets of NCCI and are protected by copyright and other intellectual property laws The uses of these materials are governed by a separate contractual agreement between NCCI and its licensees such as an affiliation agreement between NCCI and an end user Unless expressly authorized by NCCI you may not copy create derivative works (by way of example create or supplement your own works or other materials) display perform or use the materials in whole or in part in any media Such actions taken by you or by your direction may be in violation of federal copyright and other commercial laws NCCI does not permit or agree to such use of its materials In the event such use is contemplated or desired please contact NCCIs Legal Department for permission

NCCI MAKES NO REPRESENTATIONS OR WARRANTIES RELATING TO THESE MATERIALS INCLUDING ANY EXPRESS STATUTORY OR IMPLIED W ARRANTIES INCLUDING THE IMPLIED WARRANTY OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE ADDITIONALLY AUTHORIZED END USERS ASSUME RESPONSIBILITY FOR THE USE OF AND FOR ANY AND ALL RESULTS DERIVED OR OBTAINED THROUGH THE USE OF SUCH MATERIALS

Background and Filing Procedure 1

Proposed Changes in Voluntary Loss Costs and Assigned Risk Rates 2

Key Components Experience 3

Trend 4

Benefits 12

Loss-based Expenses 13

Assigned Risk Market 14

Conclusion 17

Exhibits Exhibit I - Connecticut Historical Loss Cost and Assigned Risk Rate Level Changes 18

Exhibit II - Connecticut Written Premium 19

Exhibit III - Connecticut Largest Workers Compensation Writers CY 2013 20

Exhibit IV - Proposed Voluntary Market Loss Costs and Rating Values 21

Exhibit V - Proposed Assigned Risk Rates and Rating Values 32

NCCI Key Contacts 40

Affiliate List 41

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Table of Contents

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Background and Filing Procedure

The workers compensation benefit system is designed to cover medical costs associated with workplace injuries as well as provide wage replacement (indemnity) benefits to injured workers for lost work time

The National Council on Compensation Insurance Inc (NCCI) collects an extensive amount of information regarding the workers compensation system in Connecticut and submits proposed advisory prospective loss costs (for the voluntary market) and rates (for the assigned risk market) for review and approval by the Connecticut Insurance Commissioner

The advisory prospective loss costs are intended to cover the indemnity and medical benefits provided under the system as well as some of the expenses associated with providing these benefits (loss adjustment expenses) The assigned risk rates additionally contemplate other costs associated with providing workers compensation insurance (such as commissions taxes etc)

Each insurance company offering workers compensation insurance in Connecticut must file a loss cost multiplier to be applied to the approved advisory prospective loss costs in order to compute the final workers compensation rates they intend to charge This multiplier is intended to cover the other costs associated with providing workers compensation insurance that are not already part of the advisory prospective loss costs

In this filing NCCI is proposing that the Connecticut Insurance Department approve a -06 change to the current voluntary loss costs (which went into effect on 112014) and that the new loss costs take effect on 112015 This document will explain why this change is necessary

Employers unable to secure coverage in the voluntary market can apply for such coverage in the assigned risk market In this filing NCCI is also proposing that the Connecticut Insurance Department approve a -05 change to the current assigned risk rate level (which went into effect on 112014) and that the new rates take effect on 112015

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

1

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Proposed Overall Average Change in Voluntary Loss Cost Level

Key Component Percentage Change

Experience and Trend -04 Benefits -02 Loss-based Expenses 00

Overall Loss Cost Level Change Requested -06

The change in loss costs varies depending on the classification Each classification belongs to one of five industry groups The average voluntary loss cost level change proposed for each of these five groups is displayed below as well as the largest increase and largest decrease possible for a classification in each of those groups

OVERALL AVERAGE LOSS COST LEVEL CHANGE

-06

GOODS amp SERVICES +06

Maximum Increase +21 Maximum Decrease -19

MANUFACTURING -05

Maximum Increase +20 Maximum Decrease -20

CONTRACTING -05

Maximum Increase +20 Maximum Decrease -20

MISCELLANEOUS -14

Maximum Increase +19 Maximum Decrease -21

OFFICE amp CLERICAL -32

Maximum Increase +17 Maximum Decrease -23

Proposed Overall Average Change in Assigned Risk Rate Level

Key Component Percentage Change

Overall Voluntary Loss Cost Level Change -06 Change in Assigned Risk Multiplier +01

Overall Rate Level Change Requested -05

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

2

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components

There are four key components in this filing experience trend benefits and expenses They will each be separately discussed

Experience

NCCI analyzed the emerging experience of Connecticut workers compensation policies in recent years The primary focus of our analysis was on premiums and losses from policy years 2011 and 2012 evaluated as of December 31 2013 (a policy year captures the premiums and losses from the block of policies that had effective dates during a given year) The most recently available full policy year is 2012 since the last policy had an effective date of December 31 2012 and did not expire until December 31 2013 The use of the two most recently available full policy years of data is most appropriate in providing balance between stability and responsiveness

It should be noted that NCCI adjusts (via premium and loss on-level factors) the historical policy year experience to reflect approved loss cost and rate level changes as well as statutory benefit level changes implemented since that time period NCCIs standard methodology is to utilize statewide (combined voluntary and assigned risk) market data after it has been adjusted to the current voluntary pure premium level in the calculation of the overall average loss cost level change

Different aggregations of limited loss experience were analyzed in preparation of this filing These were (i) paid losses (benefit amounts already paid by insurers on reported claims) and (ii) the sum of paid losses plus case reserves (paid losses and the amounts set aside to cover future payments on those claims) For use in this filing NCCI utilized loss development factors based on an average of each of these two loss aggregations This is consistent with NCCI filings made in the past several years in Connecticut Loss development factors are needed since paid losses and case reserve estimates on a given claim change over time until the claim is finally closed The loss development factors are based on how paid losses and case reserve estimates changed over time for Connecticut claims from older years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

3

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 6: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

Background and Filing Procedure 1

Proposed Changes in Voluntary Loss Costs and Assigned Risk Rates 2

Key Components Experience 3

Trend 4

Benefits 12

Loss-based Expenses 13

Assigned Risk Market 14

Conclusion 17

Exhibits Exhibit I - Connecticut Historical Loss Cost and Assigned Risk Rate Level Changes 18

Exhibit II - Connecticut Written Premium 19

Exhibit III - Connecticut Largest Workers Compensation Writers CY 2013 20

Exhibit IV - Proposed Voluntary Market Loss Costs and Rating Values 21

Exhibit V - Proposed Assigned Risk Rates and Rating Values 32

NCCI Key Contacts 40

Affiliate List 41

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Table of Contents

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Background and Filing Procedure

The workers compensation benefit system is designed to cover medical costs associated with workplace injuries as well as provide wage replacement (indemnity) benefits to injured workers for lost work time

The National Council on Compensation Insurance Inc (NCCI) collects an extensive amount of information regarding the workers compensation system in Connecticut and submits proposed advisory prospective loss costs (for the voluntary market) and rates (for the assigned risk market) for review and approval by the Connecticut Insurance Commissioner

The advisory prospective loss costs are intended to cover the indemnity and medical benefits provided under the system as well as some of the expenses associated with providing these benefits (loss adjustment expenses) The assigned risk rates additionally contemplate other costs associated with providing workers compensation insurance (such as commissions taxes etc)

Each insurance company offering workers compensation insurance in Connecticut must file a loss cost multiplier to be applied to the approved advisory prospective loss costs in order to compute the final workers compensation rates they intend to charge This multiplier is intended to cover the other costs associated with providing workers compensation insurance that are not already part of the advisory prospective loss costs

In this filing NCCI is proposing that the Connecticut Insurance Department approve a -06 change to the current voluntary loss costs (which went into effect on 112014) and that the new loss costs take effect on 112015 This document will explain why this change is necessary

Employers unable to secure coverage in the voluntary market can apply for such coverage in the assigned risk market In this filing NCCI is also proposing that the Connecticut Insurance Department approve a -05 change to the current assigned risk rate level (which went into effect on 112014) and that the new rates take effect on 112015

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

1

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Proposed Overall Average Change in Voluntary Loss Cost Level

Key Component Percentage Change

Experience and Trend -04 Benefits -02 Loss-based Expenses 00

Overall Loss Cost Level Change Requested -06

The change in loss costs varies depending on the classification Each classification belongs to one of five industry groups The average voluntary loss cost level change proposed for each of these five groups is displayed below as well as the largest increase and largest decrease possible for a classification in each of those groups

OVERALL AVERAGE LOSS COST LEVEL CHANGE

-06

GOODS amp SERVICES +06

Maximum Increase +21 Maximum Decrease -19

MANUFACTURING -05

Maximum Increase +20 Maximum Decrease -20

CONTRACTING -05

Maximum Increase +20 Maximum Decrease -20

MISCELLANEOUS -14

Maximum Increase +19 Maximum Decrease -21

OFFICE amp CLERICAL -32

Maximum Increase +17 Maximum Decrease -23

Proposed Overall Average Change in Assigned Risk Rate Level

Key Component Percentage Change

Overall Voluntary Loss Cost Level Change -06 Change in Assigned Risk Multiplier +01

Overall Rate Level Change Requested -05

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

2

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components

There are four key components in this filing experience trend benefits and expenses They will each be separately discussed

Experience

NCCI analyzed the emerging experience of Connecticut workers compensation policies in recent years The primary focus of our analysis was on premiums and losses from policy years 2011 and 2012 evaluated as of December 31 2013 (a policy year captures the premiums and losses from the block of policies that had effective dates during a given year) The most recently available full policy year is 2012 since the last policy had an effective date of December 31 2012 and did not expire until December 31 2013 The use of the two most recently available full policy years of data is most appropriate in providing balance between stability and responsiveness

It should be noted that NCCI adjusts (via premium and loss on-level factors) the historical policy year experience to reflect approved loss cost and rate level changes as well as statutory benefit level changes implemented since that time period NCCIs standard methodology is to utilize statewide (combined voluntary and assigned risk) market data after it has been adjusted to the current voluntary pure premium level in the calculation of the overall average loss cost level change

Different aggregations of limited loss experience were analyzed in preparation of this filing These were (i) paid losses (benefit amounts already paid by insurers on reported claims) and (ii) the sum of paid losses plus case reserves (paid losses and the amounts set aside to cover future payments on those claims) For use in this filing NCCI utilized loss development factors based on an average of each of these two loss aggregations This is consistent with NCCI filings made in the past several years in Connecticut Loss development factors are needed since paid losses and case reserve estimates on a given claim change over time until the claim is finally closed The loss development factors are based on how paid losses and case reserve estimates changed over time for Connecticut claims from older years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

3

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 7: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Background and Filing Procedure

The workers compensation benefit system is designed to cover medical costs associated with workplace injuries as well as provide wage replacement (indemnity) benefits to injured workers for lost work time

The National Council on Compensation Insurance Inc (NCCI) collects an extensive amount of information regarding the workers compensation system in Connecticut and submits proposed advisory prospective loss costs (for the voluntary market) and rates (for the assigned risk market) for review and approval by the Connecticut Insurance Commissioner

The advisory prospective loss costs are intended to cover the indemnity and medical benefits provided under the system as well as some of the expenses associated with providing these benefits (loss adjustment expenses) The assigned risk rates additionally contemplate other costs associated with providing workers compensation insurance (such as commissions taxes etc)

Each insurance company offering workers compensation insurance in Connecticut must file a loss cost multiplier to be applied to the approved advisory prospective loss costs in order to compute the final workers compensation rates they intend to charge This multiplier is intended to cover the other costs associated with providing workers compensation insurance that are not already part of the advisory prospective loss costs

In this filing NCCI is proposing that the Connecticut Insurance Department approve a -06 change to the current voluntary loss costs (which went into effect on 112014) and that the new loss costs take effect on 112015 This document will explain why this change is necessary

Employers unable to secure coverage in the voluntary market can apply for such coverage in the assigned risk market In this filing NCCI is also proposing that the Connecticut Insurance Department approve a -05 change to the current assigned risk rate level (which went into effect on 112014) and that the new rates take effect on 112015

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

1

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Proposed Overall Average Change in Voluntary Loss Cost Level

Key Component Percentage Change

Experience and Trend -04 Benefits -02 Loss-based Expenses 00

Overall Loss Cost Level Change Requested -06

The change in loss costs varies depending on the classification Each classification belongs to one of five industry groups The average voluntary loss cost level change proposed for each of these five groups is displayed below as well as the largest increase and largest decrease possible for a classification in each of those groups

OVERALL AVERAGE LOSS COST LEVEL CHANGE

-06

GOODS amp SERVICES +06

Maximum Increase +21 Maximum Decrease -19

MANUFACTURING -05

Maximum Increase +20 Maximum Decrease -20

CONTRACTING -05

Maximum Increase +20 Maximum Decrease -20

MISCELLANEOUS -14

Maximum Increase +19 Maximum Decrease -21

OFFICE amp CLERICAL -32

Maximum Increase +17 Maximum Decrease -23

Proposed Overall Average Change in Assigned Risk Rate Level

Key Component Percentage Change

Overall Voluntary Loss Cost Level Change -06 Change in Assigned Risk Multiplier +01

Overall Rate Level Change Requested -05

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

2

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components

There are four key components in this filing experience trend benefits and expenses They will each be separately discussed

Experience

NCCI analyzed the emerging experience of Connecticut workers compensation policies in recent years The primary focus of our analysis was on premiums and losses from policy years 2011 and 2012 evaluated as of December 31 2013 (a policy year captures the premiums and losses from the block of policies that had effective dates during a given year) The most recently available full policy year is 2012 since the last policy had an effective date of December 31 2012 and did not expire until December 31 2013 The use of the two most recently available full policy years of data is most appropriate in providing balance between stability and responsiveness

It should be noted that NCCI adjusts (via premium and loss on-level factors) the historical policy year experience to reflect approved loss cost and rate level changes as well as statutory benefit level changes implemented since that time period NCCIs standard methodology is to utilize statewide (combined voluntary and assigned risk) market data after it has been adjusted to the current voluntary pure premium level in the calculation of the overall average loss cost level change

Different aggregations of limited loss experience were analyzed in preparation of this filing These were (i) paid losses (benefit amounts already paid by insurers on reported claims) and (ii) the sum of paid losses plus case reserves (paid losses and the amounts set aside to cover future payments on those claims) For use in this filing NCCI utilized loss development factors based on an average of each of these two loss aggregations This is consistent with NCCI filings made in the past several years in Connecticut Loss development factors are needed since paid losses and case reserve estimates on a given claim change over time until the claim is finally closed The loss development factors are based on how paid losses and case reserve estimates changed over time for Connecticut claims from older years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

3

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 8: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Proposed Overall Average Change in Voluntary Loss Cost Level

Key Component Percentage Change

Experience and Trend -04 Benefits -02 Loss-based Expenses 00

Overall Loss Cost Level Change Requested -06

The change in loss costs varies depending on the classification Each classification belongs to one of five industry groups The average voluntary loss cost level change proposed for each of these five groups is displayed below as well as the largest increase and largest decrease possible for a classification in each of those groups

OVERALL AVERAGE LOSS COST LEVEL CHANGE

-06

GOODS amp SERVICES +06

Maximum Increase +21 Maximum Decrease -19

MANUFACTURING -05

Maximum Increase +20 Maximum Decrease -20

CONTRACTING -05

Maximum Increase +20 Maximum Decrease -20

MISCELLANEOUS -14

Maximum Increase +19 Maximum Decrease -21

OFFICE amp CLERICAL -32

Maximum Increase +17 Maximum Decrease -23

Proposed Overall Average Change in Assigned Risk Rate Level

Key Component Percentage Change

Overall Voluntary Loss Cost Level Change -06 Change in Assigned Risk Multiplier +01

Overall Rate Level Change Requested -05

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

2

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components

There are four key components in this filing experience trend benefits and expenses They will each be separately discussed

Experience

NCCI analyzed the emerging experience of Connecticut workers compensation policies in recent years The primary focus of our analysis was on premiums and losses from policy years 2011 and 2012 evaluated as of December 31 2013 (a policy year captures the premiums and losses from the block of policies that had effective dates during a given year) The most recently available full policy year is 2012 since the last policy had an effective date of December 31 2012 and did not expire until December 31 2013 The use of the two most recently available full policy years of data is most appropriate in providing balance between stability and responsiveness

It should be noted that NCCI adjusts (via premium and loss on-level factors) the historical policy year experience to reflect approved loss cost and rate level changes as well as statutory benefit level changes implemented since that time period NCCIs standard methodology is to utilize statewide (combined voluntary and assigned risk) market data after it has been adjusted to the current voluntary pure premium level in the calculation of the overall average loss cost level change

Different aggregations of limited loss experience were analyzed in preparation of this filing These were (i) paid losses (benefit amounts already paid by insurers on reported claims) and (ii) the sum of paid losses plus case reserves (paid losses and the amounts set aside to cover future payments on those claims) For use in this filing NCCI utilized loss development factors based on an average of each of these two loss aggregations This is consistent with NCCI filings made in the past several years in Connecticut Loss development factors are needed since paid losses and case reserve estimates on a given claim change over time until the claim is finally closed The loss development factors are based on how paid losses and case reserve estimates changed over time for Connecticut claims from older years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

3

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 9: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components

There are four key components in this filing experience trend benefits and expenses They will each be separately discussed

Experience

NCCI analyzed the emerging experience of Connecticut workers compensation policies in recent years The primary focus of our analysis was on premiums and losses from policy years 2011 and 2012 evaluated as of December 31 2013 (a policy year captures the premiums and losses from the block of policies that had effective dates during a given year) The most recently available full policy year is 2012 since the last policy had an effective date of December 31 2012 and did not expire until December 31 2013 The use of the two most recently available full policy years of data is most appropriate in providing balance between stability and responsiveness

It should be noted that NCCI adjusts (via premium and loss on-level factors) the historical policy year experience to reflect approved loss cost and rate level changes as well as statutory benefit level changes implemented since that time period NCCIs standard methodology is to utilize statewide (combined voluntary and assigned risk) market data after it has been adjusted to the current voluntary pure premium level in the calculation of the overall average loss cost level change

Different aggregations of limited loss experience were analyzed in preparation of this filing These were (i) paid losses (benefit amounts already paid by insurers on reported claims) and (ii) the sum of paid losses plus case reserves (paid losses and the amounts set aside to cover future payments on those claims) For use in this filing NCCI utilized loss development factors based on an average of each of these two loss aggregations This is consistent with NCCI filings made in the past several years in Connecticut Loss development factors are needed since paid losses and case reserve estimates on a given claim change over time until the claim is finally closed The loss development factors are based on how paid losses and case reserve estimates changed over time for Connecticut claims from older years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

3

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 10: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Trend

As noted previously the filing relies primarily on the experience from policy years 2011 and 2012 However the proposed loss costs are intended for use with policies with effective dates starting on January 1 2015 It is necessary to use trend factors that forecast how much the future Connecticut workers compensation experience will differ from the past These trend factors measure anticipated changes in the amount of indemnity and medical benefits as compared with anticipated changes in the amount of workersrsquo wages For example if benefit costs are expected to grow faster than wages then a trend factor greater than zero is indicated Conversely if wages are expected to grow faster than benefit costs then a trend factor less than zero is indicated

In order to appreciate the impact of the various filing components on overall system costs it is helpful to consider the separate indemnity and medical segments of Connecticut benefit costs

Distribution of Connecticut Benefit Costs

Medical 49

Indemnity 51

As can be seen Connecticutrsquos total benefit costs are roughly split half and half for indemnity and medical benefits

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

4

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 11: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

170

180

166

140 2005 2006 2007 2008 2009

Policy Year

2010 2011 2012

164

159 157 157

165

156

150 150

160

Fre

qu

ency

per

Mill

ion

of

On

-Lev

eled

W

age-

Ad

just

ed P

rem

ium

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us begin by analyzing a measure of the number of workplace injuries (claim frequency) and the average cost of each of these injuries (claim severity) The chart below summarizes the recent history of Connecticut lost-time claims (ie those claims where a worker has received wage replacement benefits due to a compensable workplace injury) The data in the chart reflect premiums at todayrsquos loss cost and wage levels

Connecticut Claim Frequency

As this chart illustrates Connecticutrsquos lost-time claim frequency has generally declined since policy year 2005

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

5

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 12: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

35000

32168 31972

27317

29362

31303

28234

26379

31421

Ave

rag

e C

ost

Per

Cas

e

30000

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Let us look at the indemnity side of benefits The chart below shows Connecticutrsquos historical average indemnity cost per case figures for the most recent eight years The data in the chart below reflect losses at todayrsquos statutory benefit levels

Connecticut Indemnity Cost Per Case

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

6

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 13: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

35000 33682

31716 31443

30248

32638 32649 31972

30000

Ave

rag

e C

ost

Per

Cas

e

29170

25000

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Indemnity Cost Per Case Adjusted to Current Wage Level

Average indemnity costs have become relatively stable in recent years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

7

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 14: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

070

0526

0479 0500

0528

0474

0538

0508 0481

040

050

060

Ind

emn

ity

Lo

ss R

atio

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Indemnity Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The indemnity loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in Connecticutrsquos average indemnity cost per case An indemnity loss ratio represents the proportion of premium dollars that are necessary to cover indemnity (wage replacement) benefits on behalf of injured workers The data in the chart reflect premiums at todayrsquos loss costs and losses at todayrsquos statutory benefit levels

Connecticut Indemnity Loss Ratio History

The chart above reveals that indemnity loss ratios have shown a volatile pattern In last yearrsquos Connecticut filing NCCI proposed an indemnity trend factor of -10 per year Based on our analysis this year we are proposing to change the indemnity trend factor to -05 per year since the longer-term patterns suggest a trend closer to 00

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

8

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 15: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

35000

22827

26898 25992

26889 28190

29053

30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

22786

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Connecticutrsquos average medical cost per lost-time case (claim severity) is tracked in the following chart The data in the chart below reflect losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Cost Per Lost-time Case

The chart shows that Connecticutrsquos average medical severity figures have increased significantly over the period displayed

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

9

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 16: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

35000

26493

25210

28806 27969

28789 29296 29494 30813

25000

30000

Ave

rag

e C

ost

Per

Cas

e

20000 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Cost Per Case (Based on an Average of Paid and Paid+Case Losses)

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

In this chart the impact of the growth in workersrsquo wages that occurred over this time period has been removed

Connecticut Medical Cost Per Lost-time Case Adjusted to Current Wage Level

In Connecticut the average medical cost per lost-time case has increased at a much faster pace than wages over the period shown

(Note Unlike indemnity benefits the level of workers compensation medical benefits is not directly based on average weekly wages Even so it is still instructive to review the changes in medical average cost per lost-time case in excess of wage growthmdashas this allows one to combine the change in the wage-adjusted medical average cost per lost-time case by the similarly-adjusted change in claim frequency in order to approximate the change over time in the overall medical loss ratios)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

10

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 17: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

070

060

050 0482

030 2005 2006 2007 2008 2009 2010 2011 2012

Policy Year

Policy Year Medical Loss Ratios (Based on an Average of Paid and Paid+Case Losses)

0440 0414

0458 0438

0451 0459 0464

040

Med

ical

Lo

ss R

atio

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The medical loss ratios below result after combining the observed changes in Connecticutrsquos average claim frequency with the corresponding changes in the average medical cost per lost-time case A medical loss ratio represents the proportion of premium dollars that are necessary to cover medical benefits on behalf of injured workers The data in the chart reflect premiums adjusted to todayrsquos loss costs and losses adjusted to todayrsquos statutory benefit levels

Connecticut Medical Loss Ratio History

As can be seen the medical loss ratios have generally increased In last yearrsquos Connecticut filing NCCI proposed a medical trend factor of +15 per year Based on our analysis this year we are proposing no change to the current medical trend factor of +15 per year This means that the rate of growth in medical benefits is once again expected to increase at a faster pace than workersrsquo wages

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

11

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 18: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Benefits

Change in Statewide Average Weekly Wage

Workers injured in Connecticut receive wage replacement (indemnity) benefits at an after-tax rate of 75 of their pre-injury weekly wage These benefits are subject to a weekly minimum and maximum

Each year on October 1 the minimum and maximum weekly benefits are updated based on the most recent average weekly wage in Connecticut NCCI estimates that the October 1 2014 update will slightly increase certain benefits and slightly decrease others with an average impact on indemnity benefits of 00

Change in Practitioner Fee Schedule

Connecticutrsquos Practitioner Fee Schedule was revised effective July 15 2014 The changes include updates to the maximum allowable reimbursements (MARs) for physicians services and durable medical equipment (DME) NCCI estimates that the impact of this change on medical benefits is -04

Total Impact

The overall impact of the above mentioned indemnity and medical benefit changes is a change in overall benefits (indemnity and medical) of -02

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

12

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 19: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Key Components (Continued)

Loss-based Expenses

The proposed loss costs include a provision for loss adjustment expenses (LAE) These expenses are directly associated with the handling of workers compensation claims

LAE is included in the loss costs by using a ratio of loss adjustment expense dollars to loss dollars (called the LAE provision) After examining LAE indications based on both Connecticut-specific data and countrywide data NCCI is proposing no change to the currently approved LAE provision of 171 of losses which has an impact of 00 on loss costs

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

13

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 20: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market

As previously mentioned an overall average decrease of 05 to the current assigned risk rate level is being proposed effective January 1 2015 The change due to experience trend and benefits is the same as for the voluntary loss costs that is -06 This filing also proposes a 01 increase to the current assigned risk loss cost multiplier underlying the latest approved assigned risk rates effective January 1 2014

Assigned Risk Expense Components

NCCI develops full rates for the assigned risk market The full rates reflect the expenses outlined below

1 Servicing Carrier AllowancemdashNCCI is the Plan Administrator for the Connecticut assigned risk market The servicing carrier allowance is a market based cost intended to compensate the servicing carriers for expenses incurred in handling the assigned risk business The servicing carrier expense includes loss adjustment expense general expense production expense (excluding commission) and taxes The weighted average servicing carrier allowance in Connecticut is 272

2 Agent CommissionmdashIn Connecticut commission rates decrease as premium size increases according to a sliding scale NCCI reviewed the latest distribution of policies by size in the Connecticut assigned risk market Based on this review NCCI is recommending a commission provision of 45

3 Administrative ExpensemdashNCCI has reviewed the administrative expense for the assigned risk market and is recommending a provision of 54 This represents the NCCI Administrative Expense along with Servicing Carrier Other Expenses which are not contemplated in the Servicing Carrier Allowance

4 Underwriting Contingencies ProvisionmdashA contingency provision for uncertainties related to the cost of reinsurance changes in assessments and insurance company insolvencies is included in the underwriting contingency provision This filing proposes no change to the currently approved provision of 00

5 Expense ConstantmdashNCCI is proposing no change to the currently approved $220 expense constant The expense constant represents a per policy fee intended to ensure equity among policyholders by recognizing economies of scale

6 Uncollectible Premium ProvisionmdashNCCI is proposing no change to the currently approved provision of 47

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

14

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 21: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Assigned Risk Market Pricing Programs

The following programs have been instituted in Connecticut

Take-out Credit Program Assigned Risk Differential Loss Sensitive Rating Plan (LSRP) Assigned Risk Adjustment Program (ARAP) Reduction of Assigned Risk Premium Discounts

These programs are intended to ensure the assigned risk (AR) market will not be competitive with the voluntary market provide incentive for AR employers to seek voluntary market coverage provide incentive to emphasize a safe workplace and loss control and make the AR market more self-funded reducing the potential for deficits This filing is proposing no change to the approved programs listed above

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

15

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 22: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

120

100 100

84

Mar

ket

Sh

are

80 73 65

60

64

5147

43 383540

20

00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NCCI Residual Market Management Summary

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

The following chart shows the history of assigned risk market shares in Connecticut After declining for several years the assigned risk market share has begun to increase in recent years

Connecticut Assigned Risk Market Shares

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

16

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 23: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

Conclusion

This filing document provides a high-level perspective in support of decreasing Connecticutrsquos current loss cost and assigned risk rate levels by an average of 06 and 05 respectively

Here are some of the key observations

Lost-time claim frequency is generally decreasing

While average indemnity costs have moderated the average medical cost per case continues to increase at a faster pace than wages

Loss experience for policy year 2012 in Connecticut is very favorable compared to policy year 2010 which is no longer in the experience period

A modest overall loss cost level decrease is needed to maintain balance between premiums and costs

The following pages contain additional exhibits that may be of interest as well as the proposed voluntary loss costs assigned risk rates and rating values by classification

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

17

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 24: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

Ap

pro

ved

Ch

ang

e

Connecticut Historical Loss Cost and

Assigned Risk Rate Level Changes150

101 100

70 71

58 57 4650

3225 25

04 00

112010 112011 112012 112013 112014

Effective Date

Voluntary Assigned Risk

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT I

The chart above shows the average approved voluntary loss cost and assigned risk rate level changes in Connecticut for each of the last five years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

18

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 25: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

Wri

tten

Pre

miu

m (

$ m

illio

ns)

818 800 850

729 732 731 737750 689 680678700 650 606590 600 550 500 450 400 350 300 250 200 150 100 50 0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Calendar Year

Preliminary Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT II

Connecticut Written Premium

This exhibit illustrates Connecticutrsquos calendar year written premium totals for the latest ten years

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

19

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 26: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

Travelers Group 141

Hartford Fire amp Casualty 169

All Other Carriers 474

Liberty Mutual Group 102

WR Berkley Group Zurich American Ins 64

Co 50

Source NAIC Annual Statement Data

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT III

Connecticut Largest Workers Compensation Writers CY 2013

The five largest insurance company groups providing workers compensation insurance in Connecticut in 2013 are shown in this chart

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

20

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 27: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT IV

Proposed Voluntary Market Loss Costs and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

21

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 28: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S1 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

0005 504 246 033 2003 735 355 033 2701 1856 798 027 0008 416 193 030 2014 823 354 027 2702 3786 1407 022 0016 664 286 027 2016 344 171 035 2709 1914 822 027 0034 536 259 033 2021 529 244 030 2710 1254 512 023 0035 348 174 035 2039 693 348 035 2714 690 345 035

0036 639 309 033 2041 571 286 035 2731 650 281 027 0037 515 238 030 2065 499 241 033 2735 695 348 035 0042X 1214 558 030 2070 877 424 033 2759 699 349 035 0050 1049 506 033 2081 535 261 033 2790 261 131 035 0059D 032 006 022 2089 555 270 033 2797 754 365 033

0065D 005 001 027 2095 516 250 033 2799 567 258 030 0066D 005 001 027 2105 547 274 035 2802 883 407 030 0067D 005 001 027 2110 369 185 035 2812 ndash 303 033 0079 416 181 027 2111 420 210 035 2835 634 337 038 0083 896 435 033 2112 549 275 035 2836 419 223 038

0106 1955 795 023 2114 277 139 035 2841 524 262 035 0113 627 304 033 2121 229 111 033 2881 519 276 038 0170 627 304 033 2130 406 197 033 2883 626 303 033 0251 598 290 033 2131 417 202 033 2913 520 277 038 0400 1150 527 030 2143 415 209 035 2915 460 211 030

0401 1421 578 023 2157 1398 676 033 2916 528 215 023 0767N 059 ndash ndash 2172 355 162 030 2923 325 163 035 0771N 076 ndash ndash 2174 487 243 035 2942 353 187 038 0908PX 17400 8415 033 2211 1348 583 027 2960 648 313 033 0913PX 70300 34048 033 2220 413 200 033 3004 401 172 027

0917 642 321 035 2286 349 175 035 3018 740 320 027 0918X 171 083 033 2288 624 311 035 3022 1374 687 035 1005 939 346 022 2300 434 229 037 3027 889 383 027 1164D 996 365 022 2302 460 222 033 3028 610 295 033 1165D 660 265 023 2305 421 194 030 3030 1451 627 027

1320 364 147 023 2361 330 160 033 3040 839 362 027 1322 1560 629 023 2362 227 110 033 3041 831 402 033 1430 979 423 027 2380 375 182 033 3042 768 352 030 1438 728 295 023 2386 233 116 035 3064 723 351 033 1452 481 207 027 2388 251 125 035 3069 ndash 254 033

1463 1117 453 023 2402 361 156 027 3076 524 254 033 1472 674 275 023 2413 444 215 033 3081D 939 403 027 1624D 655 264 023 2416 290 141 033 3082D 665 285 027 1642 538 232 027 2417 233 113 033 3085D 1032 446 027 1654 1487 641 027 2501 367 178 033 3110 1149 556 033

1655 589 252 027 2503 273 136 035 3111 380 185 033 1699 613 265 027 2534 318 160 035 3113 354 171 033 1701 1072 466 027 2560X 223 118 037 3114 386 186 033 1710 773 332 027 2570 659 329 035 3118 314 157 035 1741D 623 218 022 2585 745 373 035 3119 278 148 038

1747 531 230 027 2586 488 238 033 3120X 240 126 037 1748 632 274 027 2587 874 435 035 3122 252 127 035 1803D 1209 479 023 2589 260 126 033 3126 427 209 033 1852D 495 181 022 2600 499 247 035 3131 333 163 033 1853 400 182 030 2623 929 427 030 3132 465 226 033

1860 471 235 035 2651 238 120 035 3145 369 179 033 1924 485 242 035 2660 392 196 035 3146 454 221 033 1925 539 249 030 2670 286 152 038 3169 789 388 033 2001 ndash 355 033 2683 323 162 035 3175D 652 314 033 2002 462 232 035 2688 334 167 035 3179 380 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

22

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 29: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S2 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

3180 305 153 035 3865 465 250 038 4557 416 208 035 3188 306 153 035 3881 851 409 033 4558 350 170 033 3220 284 137 033 4000 585 237 023 4561 ndash 173 030 3223 434 232 038 4021 1312 565 027 4568 382 164 027 3224 582 288 035 4024D 599 258 027 4581 165 067 023

3227 345 171 035 4034 1107 478 027 4583 925 376 023 3240 365 183 035 4036 315 136 027 4611 117 058 035 3241 537 261 033 4038 352 187 038 4635 436 162 022 3255 297 158 038 4053 391 190 033 4653 250 125 035 3257 363 176 033 4061 632 314 035 4665 1163 501 027

3270 407 197 033 4062 245 119 033 4670 1188 516 027 3300 634 308 033 4101 433 199 030 4683 478 231 033 3303 510 255 035 4109 204 102 035 4686 360 155 027 3307 728 351 033 4110 373 181 033 4692 093 047 035 3315 654 323 035 4111 306 152 035 4693 074 036 033

3334 492 237 033 4112 ndash 181 033 4703 490 239 033 3336 545 235 027 4113 264 127 033 4717 375 199 038 3365 1562 672 027 4114 444 215 033 4720 223 108 033 3372 612 282 030 4130 758 368 033 4740 193 083 027 3373 719 348 033 4131 490 245 035 4741 377 182 033

3383 204 102 035 4133 330 165 035 4751 394 171 027 3385 129 064 035 4149 133 071 038 4767NX 479 177 022 3400 713 329 030 4150 ndash 071 038 4771N 433 162 021 3507 613 297 033 4206 563 273 033 4777 2809 1051 021 3515 308 149 033 4207 240 103 027 4825 064 028 027

3548 229 111 033 4239 271 116 027 4828 216 099 030 3559 1191 584 033 4240 318 159 035 4829 186 075 023 3574X 339 170 035 4243 503 244 033 4902 649 324 035 3581 194 097 035 4244 638 310 033 4923 277 134 033 3612 368 170 030 4250 426 208 033 5020 843 361 027

3620 690 296 027 4251 373 180 033 5022 1490 601 023 3629 266 133 035 4263 280 136 033 5037 3252 1193 022 3632 429 198 030 4273 365 177 033 5040 3192 1176 022 3634 303 152 035 4279 508 246 033 5057 1972 728 022 3635 321 155 033 4282 422 209 035 5059 5233 1934 022

3638 230 114 035 4283 386 187 033 5069 5403 1975 022 3642 213 103 033 4299 342 171 035 5102 1295 523 023 3643 445 216 033 4304 759 349 030 5146 934 401 027 3647 326 150 030 4307 352 187 038 5160 621 251 023 3648 228 114 035 4351 155 075 033 5183 699 301 027

3681 224 113 035 4352 264 132 035 5188 688 296 027 3685 207 104 035 4360 121 060 035 5190 429 185 027 3719 284 105 022 4361 136 068 035 5191 123 060 033 3724 790 319 023 4362 ndash 060 035 5192 527 255 033 3726 798 294 022 4410 601 292 033 5213 1473 597 023

3803 453 219 033 4420 755 304 023 5215 999 456 030 3807 364 182 035 4431 219 116 038 5221 1113 478 027 3808 469 215 030 4432 244 129 038 5222 1127 455 023 3821 1011 467 030 4439 377 173 030 5223 1165 501 027 3822X 813 374 030 4452 597 290 033 5348 957 412 027

3824X 1053 484 030 4459 382 185 033 5402 627 313 035 3826 203 098 033 4470 323 156 033 5403 1729 701 023 3827 294 135 030 4484 521 254 033 5437 1185 509 027 3830 186 085 030 4493 623 302 033 5443 672 324 033 3851 598 298 035 4511 068 031 030 5445 978 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

23

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 30: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S3 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

1273 1323 1407 1309

730

1102 832 373

1191 637

1903 1071

923 670

3818

599 300 738

1996 ndash

2541 2071

062 1383

936

852 507 633

2959 681

434 553

1196 808 818

601 1301 1947

309 1209

731 1087

673 644 904

1216 492 692

1011 1351

1123 439 931 740 548

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

524 628

1087 863 619

1464 1552 1174 1226

356

395 761 851 475

1017

845 461 946

1138 1967

2390 3195 2655

956 1044

1205 1027 2244

953 1461

407 739

1922 533 592

712 1122

668 1054

987

519 2185

812 902

1085

019 488 159

1663 132

243 562 140 086 075

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

427 188 418 675 222

615 458 660

1319 ndash

416 019 032

ndash ndash

ndash 1101

643 2781

288

387 893 834 324 263

312 176 241 049 157

222 484 465 382 285

283 238 261 629 139

394 143 330 153 331

1252 599 689 691 431

400 1178

610 625 667

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

24

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 31: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

ADVISORY LOSS COSTS - NOT RATES CONNECTICUT Advisory loss costs exclude all expense provisions except loss adjustment expense

Exhibit IV Page S4 Effective January 1 2015

CLASS CODE

LOSS COST ELR

DRATIO

CLASS CODE

LOSS COST ELR

DRATIO

CLASS LOSS D CODE COST ELR RATIO

8227 875 325 022 8835 342 166 033 8232 575 248 027 8842 406 198 033 8233 523 223 027 8855 023 011 033 8235 522 253 033 8856 019 009 033 8263 1140 524 030 8864 376 183 033

8264 786 339 027 8868 072 036 035 8265 1054 432 022 8869 167 084 035 8279 732 299 023 8871 017 008 035 8288 1538 676 027 8901 043 020 030 8291 783 359 030 9012 186 085 030

8292 474 231 033 9014 370 180 033 8293 1456 628 027 9015 535 259 033 8304 882 381 027 9016 456 224 033 8350 1048 426 023 9019 303 131 027 8380 487 225 030 9033X 738 359 033

8381 365 169 030 9040 475 238 035 8385X 415 179 027 9044X 222 111 035 8392 317 154 033 9052 404 203 035 8393 350 169 033 9058 268 144 038 8399X 1140 545 033 9059 ndash 084 035

8500 814 353 027 9060 227 114 035 8601 066 030 030 9061X 179 096 038 8602 077 035 030 9063 133 067 035 8603 015 007 033 9077F 272 122 032 8606 451 183 023 9082 198 106 038

8709F 416 150 020 9083 202 108 038 8719 541 201 022 9084 243 119 033 8720 275 119 027 9088a a a a 8721 036 016 027 9089 195 098 035 8723 019 009 033 9093 207 104 035

8725 360 156 027 9101 591 296 035 8726F 247 101 026 9102 477 231 033 8734M 055 024 027 9154 293 143 033 8737M 050 022 027 9156 283 131 030 8738M 067 029 027 9170 954 357 021

8742 041 018 027 9178 989 ndash 038 8745 584 270 030 9179 2167 ndash 035 8748 091 042 030 9180 671 292 027 8754X 095 046 033 9182 459 223 033 8755 055 024 027 9186 1661 679 023

8799 076 037 033 9220 545 250 030 8800 205 109 038 9402 718 309 027 8803 008 003 027 9403 1465 595 023 8805M 026 013 033 9410 280 136 033 8810 019 009 033 9501 502 231 030

8814M 023 011 033 9505 1377 625 030 8815M 031 015 033 9516 879 380 027 8820 029 013 030 9519 552 238 027 8824 548 275 035 9521 517 222 027 8825 309 165 038 9522 319 155 033

8826 344 167 033 9534 1112 449 023 8829 508 246 033 9554 1637 660 023 8831 208 102 033 9586 079 042 038 8832 059 029 033 9600 369 184 035 8833 120 058 033 9620 142 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

25

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 32: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S5 Effective January 1 2015

FOOTNOTES

a Advisory loss cost for each individual risk must be obtained from NCCI Customer Service or the Rating Organization having jurisdiction

D Advisory loss cost for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 032 S 1741D 034 S 4024D 001 S 0065D 005 S 1803D 030 S 5508D 006 S 0066D 005 S 1852D 008 Asb 6251D 004 S 0067D 005 S 3081D 008 S 6252D 004 S 1164D 009 S 3082D 006 S 6260D 005 S 1165D 003 S 3085D 008 S 1624D 003 S 3175D 004 S S=Silica Asb=Asbestos

F Advisory loss cost provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published loss cost is for risks that voluntarily purchase standard workers compensation and employers liability coverage

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding advisory loss cost are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code loss cost and elr each x 1215

6703 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost x 1624 and elr x 1624

6704 Loss cost and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class loss cost and elr each x 135

7731 Loss cost per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

26

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 33: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit IV

Page S6 Effective January 1 2015

ADVISORY MISCELLANEOUS VALUES

Advisory Loss Elimination Ratios - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis They do not include a safety factor

Total Losses Deductible Amount

$1000

HAZARD GROUP A B C D E F G

61 45 40 32 25 19 17 $5000 157 122 111 92 76 62 55

$10000 224 179 166 141 118 99 88

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 --Taxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

$91700 $61100

Catastrophe (other than Certified Acts of Terrorism) - (Advisory Loss Cost)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact

$1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E-- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Terrorism - (Advisory Loss Cost) helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 001

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification loss cost by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility

A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

27

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 34: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S7 TABLE OF WEIGHTING VALUES APPLICABLE TO ALL POLICIES Experience Rating Program - ERA

Expected Weighting Expected Weighting Losses Values Losses Values

0 -- 2356 004 1328501 -- 1401780 044 2357 -- 9523 005 1401781 -- 1479303 045 9524 -- 16844 006 1479304 -- 1561448 046

16845 -- 24324 007 1561449 -- 1648643 047 24325 -- 31967 008 1648644 -- 1741370 048

31968 -- 53467 009 1741371 -- 1840172 049 53468 -- 79588 010 1840173 -- 1945668 050 79589 -- 102823 011 1945669 -- 2058563 051

102824 -- 125445 012 2058564 -- 2179664 052 125446 -- 148071 013 2179665 -- 2309900 053

148072 -- 170976 014 2309901 -- 2450347 054 170977 -- 194314 015 2450348 -- 2602255 055 194315 -- 218191 016 2602256 -- 2767087 056 218192 -- 242687 017 2767088 -- 2946567 057 242688 -- 267867 018 2946568 -- 3142739 058

267868 -- 293791 019 3142740 -- 3358047 059 293792 -- 320516 020 3358048 -- 3595433 060 320517 -- 348095 021 3595434 -- 3858478 061 348096 -- 376585 022 3858479 -- 4151583 062 376586 -- 406043 023 4151584 -- 4480211 063

406044 -- 436526 024 4480212 -- 4851239 064 436527 -- 468097 025 4851240 -- 5273439 065 468098 -- 500822 026 5273440 -- 5758184 066 500823 -- 534770 027 5758185 -- 6320483 067 534771 -- 570016 028 6320484 -- 6980570 068

570017 -- 606639 029 6980571 -- 7766383 069 606640 -- 644725 030 7766384 -- 8717625 070 644726 -- 684366 031 8717626 -- 9892684 071 684367 -- 725663 032 9892685 -- 11381087 072 725664 -- 768724 033 11381088 -- 13327454 073

768725 -- 813665 034 13327455 -- 15981584 074 813666 -- 860617 035 15981585 -- 19815319 075 860618 -- 909717 036 19815320 -- 25839750 076 909718 -- 961118 037 25839751 -- 36683714 077 961119 -- 1014989 038 36683715 -- 61986274 078

1014990 -- 1071512 039 61986275 -- 188499016 079 1071513 -- 1130889 040 188499017 AND OVER 080 1130890 -- 1193344 041 1193345 -- 1259123 042 1259124 -- 1328500 043

(a) G 1125 (b) State Per Claim Accident Limitation $281500 (c) State Multiple Claim Accident Limitation $563000 (d) USLampHW Per Claim Accident Limitation $475500 (e) USLampHW Multiple Claim Accident Limitation $951000 (f) Employers Liability Accident Limitation $55000 (g) PrimaryExcess Loss Split Point $15500 (h) USLampHW Act -- Expected Loss Factor -- Non-F Classes 125 (Multiply a Non-F classification ELR by the USLampHW Act - Expected Loss Factor of 125)

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

28

814

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 35: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

EXPERIENCE RATING PLAN MANUAL CONNECTICUT Exhibit IV

Effective January 1 2015 Page S8 TABLE OF BALLAST VALUES

APPLICABLE TO ALL POLICIES Experience Rating Plan - ERA

Expected Losses

Ballast Values

Expected Losses

Ballast Values

Expected Losses

Ballast Values

0 -shy 60511 60512 -shy 104146

104147 -shy 154283 154284 -shy 207174 207175 -shy 261351

261352 -shy 316209 316210 -shy 371463 371464 -shy 426968 426969 -shy 482640 482641 -shy 538429

538430 -shy 594303 594304 -shy 650240 650241 -shy 706226 706227 -shy 762250 762251 -shy 818305

818306 -shy 874385 874386 -shy 930485 930486 -shy 986602 986603 -shy 1042733

1042734 -shy 1098876

1098877 -shy 1155029 1155030 -shy 1211191 1211192 -shy 1267361 1267362 -shy 1323538 1323539 -shy 1379721

1379722 -shy 1435909 1435910 -shy 1492101 1492102 -shy 1548298 1548299 -shy 1604498 1604499 -shy 1660702

1660703 -shy 1716909 1716910 -shy 1773118 1773119 -shy 1829330 1829331 -shy 1885544 1885545 -shy 1941761

28125 33750 39375 45000 50625

56250 61875 67500 73125 78750

84375 90000 95625

101250 106875

112500 118125 123750 129375 135000

140625 146250 151875 157500 163125

168750 174375 180000 185625 191250

196875 202500 208125 213750 219375

1941762 -shy 1997979 1997980 -shy 2054199 2054200 -shy 2110420 2110421 -shy 2166643 2166644 -shy 2222867

2222868 -shy 2279093 2279094 -shy 2335320 2335321 -shy 2391548 2391549 -shy 2447776 2447777 -shy 2504006

2504007 -shy 2560237 2560238 -shy 2616468 2616469 -shy 2672701 2672702 -shy 2728934 2728935 -shy 2785167

2785168 -shy 2841402 2841403 -shy 2897637 2897638 -shy 2953872 2953873 -shy 3010108 3010109 -shy 3066345

3066346 -shy 3122582 3122583 -shy 3178820 3178821 -shy 3235057 3235058 -shy 3291296 3291297 -shy 3347535

3347536 -shy 3403774 3403775 -shy 3460013 3460014 -shy 3516253 3516254 -shy 3572493 3572494 -shy 3628734

3628735 -shy 3684974 3684975 -shy 3741215 3741216 -shy 3797457 3797458 -shy 3853698 3853699 -shy 3909940

225000 230625 236250 241875 247500

253125 258750 264375 270000 275625

281250 286875 292500 298125 303750

309375 315000 320625 326250 331875

337500 343125 348750 354375 360000

365625 371250 376875 382500 388125

393750 399375 405000 410625 416250

3909941 -shy 3966182 3966183 -shy 4022424 4022425 -shy 4078666 4078667 -shy 4134909 4134910 -shy 4191152

4191153 -shy 4247395 4247396 -shy 4303638 4303639 -shy 4359882 4359883 -shy 4416125 4416126 -shy 4472369

4472370 -shy 4528613 4528614 -shy 4584857 4584858 -shy 4641101 4641102 -shy 4697345 4697346 -shy 4753590

4753591 -shy 4809834 4809835 -shy 4866079 4866080 -shy 4922324 4922325 -shy 4978569 4978570 -shy 5034814

5034815 -shy 5091059 5091060 -shy 5147304 5147305 -shy 5203549 5203550 -shy 5259795 5259796 -shy 5316041

5316042 -shy 5371875

421875 427500 433125 438750 444375

450000 455625 461250 466875 472500

478125 483750 489375 495000 500625

506250 511875 517500 523125 528750

534375 540000 545625 551250 556875

562500

For Expected Losses greater than $5371875 the Ballast Value can be calculated using the following formula (rounded to the nearest 1)

Ballast = (010)(Expected Losses) + 2500(Expected Losses)(1125) (Expected Losses + (700)(1125))

G = 1125

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

29

814

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 36: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

1 Hazard Group Differentials A B C D E F G

137 109 101 085 072 060 051

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 1

Effective January 1 2015 Exhibit IV

2 2013 Table of Expected Loss Ranges Effective January 1 2013

3 Excess Loss Pure Premium Factors (Applicable to New and Renewal Policies)

Per Accident Limitation

$10000 A

Hazard Groups B C D E F G

0663 0701 0712 0734 0752 0768 0778 $15000 0621 0663 0676 0701 0723 0742 0755 $20000 0586 0632 0646 0673 0697 0719 0734 $25000 0557 0605 0620 0649 0675 0699 0716 $30000 0532 0581 0597 0627 0655 0680 0700 $35000 0510 0560 0576 0608 0637 0664 0685 $40000 0490 0541 0558 0590 0621 0648 0671 $50000 0456 0508 0526 0559 0591 0621 0646 $75000 0394 0446 0465 0500 0534 0566 0595

$100000 0350 0402 0420 0456 0492 0524 0557 $125000 0317 0367 0386 0421 0458 0490 0525 $150000 0291 0340 0359 0393 0430 0463 0499 $175000 0270 0317 0336 0370 0407 0439 0476 $200000 0252 0298 0317 0350 0387 0418 0457 $225000 0236 0282 0301 0333 0369 0401 0439 $250000 0223 0267 0286 0318 0354 0385 0424 $275000 0212 0255 0273 0304 0340 0370 0410 $300000 0201 0244 0262 0292 0327 0358 0398 $325000 0192 0233 0252 0281 0316 0346 0386 $350000 0184 0224 0242 0271 0306 0335 0376 $375000 0176 0216 0234 0262 0297 0325 0366 $400000 0169 0208 0226 0254 0288 0316 0357 $425000 0163 0201 0219 0246 0280 0308 0348 $450000 0157 0195 0213 0239 0273 0300 0341 $475000 0152 0189 0206 0233 0266 0292 0333 $500000 0147 0183 0201 0227 0259 0286 0326 $600000 0130 0164 0181 0205 0237 0262 0302 $700000 0117 0149 0166 0189 0219 0243 0283 $800000 0106 0137 0153 0175 0204 0227 0266 $900000 0098 0127 0142 0163 0192 0213 0252

$1000000 0090 0118 0133 0153 0181 0201 0240 $2000000 0051 0071 0083 0097 0120 0134 0169 $3000000 0035 0051 0061 0072 0091 0103 0134 $4000000 0027 0040 0048 0057 0074 0084 0112 $5000000 0021 0032 0040 0048 0062 0071 0097 $6000000 0017 0027 0034 0040 0053 0061 0085 $7000000 0014 0023 0029 0035 0047 0054 0075 $8000000 0012 0020 0025 0031 0041 0048 0068 $9000000 0011 0017 0022 0027 0037 0043 0061

$10000000 0009 0015 0020 0024 0033 0039 0056

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

30

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 37: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

RETROSPECTIVE RATING PLAN MANUAL CONNECTICUT STATE SPECIAL RATING VALUES RR 2

Effective January 1 2015 Exhibit IV

Per Accident Limitation

$10000 $15000 $20000 $25000 $30000 $35000 $40000 $50000 $75000

$100000 $125000 $150000 $175000 $200000 $225000 $250000 $275000 $300000 $325000 $350000 $375000 $400000 $425000 $450000 $475000 $500000 $600000 $700000 $800000 $900000

$1000000 $2000000 $3000000 $4000000 $5000000 $6000000 $7000000 $8000000 $9000000

$10000000

A 0740 0695 0658 0627 0600 0576 0555 0519 0451 0403 0367 0338 0315 0295 0278 0263 0250 0238 0228 0218 0210 0202 0195 0188 0182 0176 0157 0141 0129 0118 0110 0063 0043 0033 0026 0021 0018 0015 0013 0011

Excess Loss and Allocated Expense Pure Premium Factors

(Applicable to New and Renewal Policies)

Hazard Groups B C D

0780 0792 0815 0740 0754 0780 0707 0722 0751 0678 0694 0725 0653 0669 0702 0630 0647 0681 0610 0628 0663 0575 0593 0630 0508 0527 0565 0459 0479 0518 0422 0442 0480 0392 0412 0450 0367 0387 0424 0346 0366 0402 0327 0348 0383 0312 0332 0366 0297 0317 0351 0285 0305 0338 0274 0293 0326 0263 0283 0315 0254 0273 0305 0245 0265 0296 0237 0257 0287 0230 0249 0279 0223 0242 0272 0217 0236 0265 0195 0213 0241 0178 0196 0221 0164 0181 0205 0152 0169 0192 0142 0158 0180 0086 0099 0115 0061 0073 0086 0048 0057 0068 0039 0047 0056 0032 0040 0048 0027 0034 0041 0024 0030 0036 0021 0026 0032 0018 0023 0028

E 0834 0803 0776 0753 0732 0712 0695 0664 0602 0556 0519 0489 0463 0441 0422 0405 0390 0376 0364 0353 0342 0333 0324 0315 0308 0300 0275 0255 0238 0224 0211 0140 0107 0087 0073 0062 0055 0048 0043 0039

F 0851 0823 0799 0778 0759 0741 0724 0695 0636 0591 0555 0524 0499 0476 0457 0439 0423 0409 0396 0385 0374 0364 0354 0345 0337 0330 0303 0281 0263 0248 0235 0158 0121 0099 0083 0072 0063 0056 0050 0045

G 0860 0836 0815 0796 0778 0762 0748 0721 0667 0625 0591 0562 0538 0516 0497 0481 0465 0452 0439 0427 0417 0407 0397 0389 0380 0373 0346 0324 0306 0290 0276 0195 0155 0129 0111 0098 0087 0078 0070 0064

4

1st Adj 010

With Loss Limit Without Loss Limit 2nd 3rd 4th 1st 2nd 3rd Adj Adj Adj Adj Adj Adj 007 006 005 042 030 025

Retrospective Pure Premium Development Factors

4th Adj 021

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

31

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 38: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

EXHIBIT V

Proposed Assigned Risk Rates and Rating Values

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

32

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 39: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S1

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

0005 891 1250 246 033 2003 1299 1250 355 033 2701 3280 1250 798 027 0008 735 1250 193 030 2014 1454 1250 354 027 2702 6690 1250 1407 022 0016 1173 1250 286 027 2016 608 1250 171 035 2709 3382 1250 822 027 0034 947 1250 259 033 2021 935 1250 244 030 2710 2216 1250 512 023 0035 615 1250 174 035 2039 1225 1250 348 035 2714 1219 1250 345 035

0036 1129 1250 309 033 2041 1009 1250 286 035 2731 1149 1250 281 027 0037 910 1250 238 030 2065 882 1250 241 033 2735 1228 1250 348 035 0042X 2146 1250 558 030 2070 1550 1250 424 033 2759 1235 1250 349 035 0050 1854 1250 506 033 2081 945 1250 261 033 2790 461 1250 131 035 0059D 057 ndash 006 022 2089 981 1250 270 033 2797 1332 1250 365 033

0065D 009 ndash 001 027 2095 912 1250 250 033 2799 1002 1250 258 030 0066D 009 ndash 001 027 2105 967 1250 274 035 2802 1560 1250 407 030 0067D 009 ndash 001 027 2110 652 1250 185 035 2812 ndash ndash 303 033 0079 735 1250 181 027 2111 742 1250 210 035 2835 1120 1250 337 038 0083 1583 1250 435 033 2112 970 1250 275 035 2836 740 1250 223 038

0106 3454 1250 795 023 2114 489 1250 139 035 2841 926 1250 262 035 0113 1108 1250 304 033 2121 405 1250 111 033 2881 917 1250 276 038 0170 1108 1250 304 033 2130 717 1250 197 033 2883 1106 1250 303 033 0251 1057 1250 290 033 2131 737 1250 202 033 2913 919 1250 277 038 0400 2032 1250 527 030 2143 733 1250 209 035 2915 813 1250 211 030

0401 2511 A 578 023 2157 2470 1250 676 033 2916 933 1250 215 023 0767N 104 ndash ndash ndash 2172 627 1250 162 030 2923 574 1250 163 035 0771N 134 ndash ndash ndash 2174 861 1250 243 035 2942 624 1250 187 038 0908PX 30700 432 8415 033 2211 2382 1250 583 027 2960 1145 1250 313 033 0913PX 124200 1250 34048 033 2220 730 1250 200 033 3004 709 1250 172 027

0917 1134 1250 321 035 2286 617 1250 175 035 3018 1308 1250 320 027 0918X 302 650 083 033 2288 1103 1250 311 035 3022 2428 1250 687 035 1005 1659 1250 346 022 2300 767 1250 229 037 3027 1571 1250 383 027 1164D 1760 1250 365 022 2302 813 1250 222 033 3028 1078 1250 295 033 1165D 1166 1250 265 023 2305 744 1250 194 030 3030 2564 1250 627 027

1320 643 1250 147 023 2361 583 1250 160 033 3040 1483 1250 362 027 1322 2757 1250 629 023 2362 401 1250 110 033 3041 1468 1250 402 033 1430 1730 1250 423 027 2380 663 1250 182 033 3042 1357 1250 352 030 1438 1286 1250 295 023 2386 412 1250 116 035 3064 1278 1250 351 033 1452 850 1250 207 027 2388 444 1250 125 035 3069 ndash ndash 254 033

1463 1974 1250 453 023 2402 638 1250 156 027 3076 926 1250 254 033 1472 1191 1250 275 023 2413 785 1250 215 033 3081D 1659 1250 403 027 1624D 1157 1250 264 023 2416 512 1250 141 033 3082D 1175 1250 285 027 1642 951 1250 232 027 2417 412 1250 113 033 3085D 1823 1250 446 027 1654 2628 1250 641 027 2501 648 1250 178 033 3110 2030 1250 556 033

1655 1041 1250 252 027 2503 482 1250 136 035 3111 671 1250 185 033 1699 1083 1250 265 027 2534 562 1250 160 035 3113 626 1250 171 033 1701 1894 1250 466 027 2560X 394 1250 118 037 3114 682 1250 186 033 1710 1366 1250 332 027 2570 1164 1250 329 035 3118 555 1250 157 035 1741D 1101 1250 218 022 2585 1316 1250 373 035 3119 491 1250 148 038

1747 938 1250 230 027 2586 862 1250 238 033 3120X 424 1250 126 037 1748 1117 1250 274 027 2587 1544 1250 435 035 3122 445 1250 127 035 1803D 2136 1250 479 023 2589 459 1250 126 033 3126 755 1250 209 033 1852D 875 1250 181 022 2600 882 1250 247 035 3131 588 1250 163 033 1853 707 1250 182 030 2623 1642 1250 427 030 3132 822 1250 226 033

1860 832 1250 235 035 2651 421 1250 120 035 3145 652 1250 179 033 1924 857 1250 242 035 2660 693 1250 196 035 3146 802 1250 221 033 1925 952 1250 249 030 2670 505 1250 152 038 3169 1394 1250 388 033 2001 ndash ndash 355 033 2683 571 1250 162 035 3175D 1152 1250 314 033 2002 816 1250 232 035 2688 590 1250 167 035 3179 671 1250 190 035

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

33

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 40: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S2

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

3180 539 1250 153 035 3865 822 1250 250 038 4557 735 1250 208 035 3188 541 1250 153 035 3881 1504 1250 409 033 4558 618 1250 170 033 3220 502 1250 137 033 4000 1034 1250 237 023 4561 ndash ndash 173 030 3223 767 1250 232 038 4021 2318 1250 565 027 4568 675 1250 164 027 3224 1028 1250 288 035 4024D 1059 1250 258 027 4581 292 1154 067 023

3227 610 1250 171 035 4034 1956 1250 478 027 4583 1634 1250 376 023 3240 645 1250 183 035 4036 557 1250 136 027 4611 207 882 058 035 3241 949 1250 261 033 4038 622 1250 187 038 4635 770 1250 162 022 3255 525 1250 158 038 4053 691 1250 190 033 4653 442 1250 125 035 3257 641 1250 176 033 4061 1117 1250 314 035 4665 2055 1250 501 027

3270 719 1250 197 033 4062 433 1250 119 033 4670 2099 1250 516 027 3300 1120 1250 308 033 4101 765 1250 199 030 4683 845 1250 231 033 3303 901 1250 255 035 4109 360 1250 102 035 4686 636 1250 155 027 3307 1286 1250 351 033 4110 659 1250 181 033 4692 164 745 047 035 3315 1156 1250 323 035 4111 541 1250 152 035 4693 131 639 036 033

3334 869 1250 237 033 4112 ndash ndash 181 033 4703 866 1250 239 033 3336 963 1250 235 027 4113 466 1250 127 033 4717 663 1250 199 038 3365 2761 1250 672 027 4114 785 1250 215 033 4720 394 1250 108 033 3372 1081 1250 282 030 4130 1339 1250 368 033 4740 341 1250 083 027 3373 1270 1250 348 033 4131 866 1250 245 035 4741 666 1250 182 033

3383 360 1250 102 035 4133 583 1250 165 035 4751 696 1250 171 027 3385 228 950 064 035 4149 235 972 071 038 4767NX 846 1250 177 022 3400 1260 1250 329 030 4150 ndash ndash 071 038 4771N 765 1250 162 021 3507 1083 1250 297 033 4206 995 1250 273 033 4777 4964 1250 1051 021 3515 544 1250 149 033 4207 424 1250 103 027 4825 113 582 028 027

3548 405 1250 111 033 4239 479 1250 116 027 4828 382 1250 099 030 3559 2104 1250 584 033 4240 562 1250 159 035 4829 329 1250 075 023 3574X 599 1250 170 035 4243 889 1250 244 033 4902 1147 1250 324 035 3581 343 1250 097 035 4244 1127 1250 310 033 4923 489 1250 134 033 3612 650 1250 170 030 4250 753 1250 208 033 5020 1489 1250 361 027

3620 1219 1250 296 027 4251 659 1250 180 033 5022 2633 1250 601 023 3629 470 1250 133 035 4263 495 1250 136 033 5037 5747 1250 1193 022 3632 758 1250 198 030 4273 645 1250 177 033 5040 5641 1250 1176 022 3634 535 1250 152 035 4279 898 1250 246 033 5057 3484 1250 728 022 3635 567 1250 155 033 4282 746 1250 209 035 5059 9247 1250 1934 022

3638 406 1250 114 035 4283 682 1250 187 033 5069 9547 1250 1975 022 3642 376 1250 103 033 4299 604 1250 171 035 5102 2288 1250 523 023 3643 786 1250 216 033 4304 1341 1250 349 030 5146 1650 1250 401 027 3647 576 1250 150 030 4307 622 1250 187 038 5160 1098 1250 251 023 3648 403 1250 114 035 4351 274 1097 075 033 5183 1235 1250 301 027

3681 396 1250 113 035 4352 466 1250 132 035 5188 1216 1250 296 027 3685 366 1250 104 035 4360 214 905 060 035 5190 758 1250 185 027 3719 501 1250 105 022 4361 240 988 068 035 5191 217 914 060 033 3724 1395 1250 319 023 4362 ndash ndash 060 035 5192 931 1250 255 033 3726 1410 1250 294 022 4410 1062 1250 292 033 5213 2602 1250 597 023

3803 800 1250 219 033 4420 1334 1250 304 023 5215 1766 1250 456 030 3807 643 1250 182 035 4431 387 1250 116 038 5221 1967 1250 478 027 3808 829 1250 215 030 4432 431 1250 129 038 5222 1992 1250 455 023 3821 1786 1250 467 030 4439 666 1250 173 030 5223 2059 1250 501 027 3822X 1437 1250 374 030 4452 1055 1250 290 033 5348 1690 1250 412 027

3824X 1861 1250 484 030 4459 675 1250 185 033 5402 1108 1250 313 035 3826 359 1250 098 033 4470 571 1250 156 033 5403 3056 1250 701 023 3827 519 1250 135 030 4484 921 1250 254 033 5437 2094 1250 509 027 3830 329 1250 085 030 4493 1101 1250 302 033 5443 1188 1250 324 033 3851 1057 1250 298 035 4511 120 604 031 030 5445 1728 1250 396 023

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

34

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 41: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S3

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

5462 5472 5473 5474 5478

5479 5480 5491 5506 5507

5508D 5509X 5535 5537 5551

5604X 5606 5610 5645 5651

5703 5705 5951 6003 6005

6017 6018 6045 6204 6206

6213 6214 6216 6217 6229

6233 6235 6236 6237 6251D

6252D 6260D 6306 6319 6325

6400 6503 6504

6702M 6703M

6704M 6801F 6811 6824F 6826F

2248 2337 2486 2313 1291

1948 1470

658 2105 1126

3363 1893 1630 1184 6745

1059 529

1305 3527

ndash

4490 3659

110 2443 1653

1505 896

1119 5228 1204

767 977

2114 1427 1445

1062 2299 3440

545 2137

1293 1921 1189 1138 1597

2149 869

1223 1786 2387

1984 776

1645 1308

968

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 1250

572 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

546 491 521 531 313

504 334 151 442 257

810 437 398 288

1418

241 121 356 810 810

1089 877 031 594 404

364 216 271

1189 252

175 205 442 327 331

241 480 837 132 482

269 395 271 260 366

557 245 345 433 580

481 179 399 288 223

027022022023027

030023023022023

027023027027022

023023033023023

027028035027027

027027027023022

023022022023023

023022027027023

022022023023023

030035035027027

027026027021026

6834 6836 6843F 6845F 6854

6872F 6874F 6882 6884 7016M

7024M 7038M 7046M 7047M 7050M

7090M 7097MX

7098M 7099M 7133

7151M 7152M 7153M 7222 7228

7229 7230 7231 7232 7309F

7313F 7317F 7327F 7333M 7335M

7337M 7350F 7360 7370 7380

7382X 7390 7394M 7395M 7398M

7402 7403 7405N 7420 7421

7422 7425 7431N 7445N 7453N

926 1110 1921 1525 1094

2587 2742 2074 2166

629

698 1345 1504

839 1797

1493 815

1672 2011 3476

4223 5646 4691 1689 1845

2129 1815 3965 1684 2582

719 1306 3396

942 1046

1258 1983 1180 1862 1744

917 3861 1435 1594 1917

034 862 281

2939 233

429 993 247 152 133

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

329 1250 1250 1250

966

1250 1250 1250

ndash ndash

241 272 392 311 230

529 560 436 450 131

145 285 314 174 381

317 260 349 420 799

970 1298 1078

410 449

488 471

1020 385 527

147 266 694 194 216

260 437 289 511 453

253 1053

300 333 401

009 212 068 605 053

090 208 051

ndash ndash

030027020020022

019020022022022

022021022022021

021046022022023

023023023027027

023030030023020

020020019022022

022021027033030

033033022022022

033027027022023

022022022

ndashndash

7502 7515 7520 7538 7539

7540 7580 7590 7600 7601

7605 7607X 7610 7611 7612

7613 7705X 7710 7711 7720X

7723X 7731X

7855 8001 8002

8006 8008 8010 8013 8015

8017 8018X 8021 8031 8032

8033 8037 8039 8044X 8045

8046 8047 8058 8072 8102

8103 8105 8106 8107 8111

8116 8203 8204 8209 8215

755 332 739

1193 392

1087 809

1166 2331

ndash

734 034 057

ndash ndash

ndash 1945 1136 4914

509

684 1578 1473

573 465

551 311 426 087 277

392 855 822 675 504

500 421 461

1111 246

696 253 583 270 585

2212 1058 1217 1221

762

707 2082 1078 1104 1179

1250 1250 1250 1250 1250

1250 1250 1250 1250

ndash

1250 329 402

ndash ndash

ndash 1250 1250 1250 1250

1250 5500 1250 1250 1250

1250 1215 1250

498 1106

1250 1250 1250 1250 1250

1250 1250 1250 1250 1007

1250 1030 1250 1084 1250

1250 1250 1250 1250 1250

1250 1250 1250 1250 1250

185 070 202 250 090

229 197 303 567 567

179 009 015 567 567

567 508 260

1129 124

144 411 357 162 128

152 088 121 024 076

112 242 226 186 143

138 120 132 289 070

192 071 161 077 167

579 300 298 299 210

195 572 264 303 290

027022033022023

021027030027027

027033030027027

027030023023027

021030027035033

033035035033033

035035033033035

033035035030035

033035033035035

030035027027033

033033027033027

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

35

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 42: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S4

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS CODE RATE

MIN PREM ELR

DRATIO

CLASS MIN D CODE RATE PREM ELR RATIO

8227 1546 1250 325 022 8835 604 1250 166 033 8232 1016 1250 248 027 8842 717 1250 198 033 8233 924 1250 223 027 8855 041 351 011 033 8235 922 1250 253 033 8856 034 329 009 033 8263 2014 1250 524 030 8864 664 1250 183 033

8264 1389 1250 339 027 8868 127 626 036 035 8265 1862 1250 432 022 8869 295 1164 084 035 8279 1293 1250 299 023 8871 030 316 008 035 8288 2718 1250 676 027 8901 076 463 020 030 8291 1384 1250 359 030 9012 329 1250 085 030

8292 838 1250 231 033 9014 654 1250 180 033 8293 2573 1250 628 027 9015 945 1250 259 033 8304 1558 1250 381 027 9016 806 1250 224 033 8350 1852 1250 426 023 9019 535 1250 131 027 8380 861 1250 225 030 9033X 1304 1250 359 033

8381 645 1250 169 030 9040 839 1250 238 035 8385X 733 1250 179 027 9044X 392 1250 111 035 8392 560 1250 154 033 9052 714 1250 203 035 8393 618 1250 169 033 9058 474 1250 144 038 8399X 2014 1250 545 033 9059 ndash ndash 084 035

8500 1438 1250 353 027 9060 401 1250 114 035 8601 117 594 030 030 9061X 316 1231 096 038 8602 136 655 035 030 9063 235 972 067 035 8603 027 306 007 033 9077F 481 1250 122 032 8606 797 1250 183 023 9082 350 1250 106 038

8709F 735 1250 150 020 9083 357 1250 108 038 8719 956 1250 201 022 9084 429 1250 119 033 8720 486 1250 119 027 9088a a a a a 8721 064 425 016 027 9089 345 1250 098 035 8723 034 329 009 033 9093 366 1250 104 035

8725 636 1250 156 027 9101 1044 1250 296 035 8726F 436 1250 101 026 9102 843 1250 231 033 8734M 097 530 024 027 9154 518 1250 143 033 8737M 088 502 022 027 9156 500 1250 131 030 8738M 118 598 029 027 9170 1686 1250 357 021

8742 072 450 018 027 9178 1748 1250 ndash 038 8745 1032 1250 270 030 9179 3829 1250 ndash 035 8748 161 735 042 030 9180 1186 1250 292 027 8754X 168 758 046 033 9182 811 1250 223 033 8755 097 530 024 027 9186 2935 1250 679 023

8799 134 649 037 033 9220 963 1250 250 030 8800 362 1250 109 038 9402 1269 1250 309 027 8803 014 265 003 027 9403 2589 1250 595 023 8805M 046 367 013 033 9410 495 1250 136 033 8810 034 329 009 033 9501 887 1250 231 030

8814M 041 351 011 033 9505 2433 1250 625 030 8815M 055 396 015 033 9516 1553 1250 380 027 8820 051 383 013 030 9519 975 1250 238 027 8824 968 1250 275 035 9521 914 1250 222 027 8825 546 1250 165 038 9522 564 1250 155 033

8826 608 1250 167 033 9534 1965 1250 449 023 8829 898 1250 246 033 9554 2893 1250 660 023 8831 368 1250 102 033 9586 140 668 042 038 8832 104 553 029 033 9600 652 1250 184 035 8833 212 898 058 033 9620 251 1023 066 030

Refer to the Footnotes Page for additional information on this class code

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

36

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 43: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

WORKERS COMPENSATION AND EMPLOYERS LIABILITY

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

CONNECTICUT Exhibit V Page S5

FOOTNOTES

a Rate for each individual risk must be obtained by NCCI Customer Service or the Rating Organization having jurisdiction

A Minimum Premium $100 per ginning location for policy minimum premium computation

D Rate for classification already includes the specific disease loading shown in the table below See Basic Manual Rule 3-A-7

Code No Disease Loading Symbol Code No

Disease Loading Symbol Code No

Disease Loading Symbol

0059D 057 S 1741D 060 S 4024D 002 S 0065D 009 S 1803D 053 S 5508D 011 S 0066D 009 S 1852D 014 Asb 6251D 007 S 0067D 009 S 3081D 014 S 6252D 007 S 1164D 016 S 3082D 011 S 6260D 009 S 1165D 005 S 3085D 014 S 1624D 005 S 3175D 007 S S=Silica Asb=Asbestos

F Rate provides for coverage under the United States Longshore and Harbor Workers Compensation Act and its extensions

M Risks are subject to Admiralty Law or Federal Employers Liability Act (FELA) However the published rate is for risks that voluntarily purchase standard workers compensation and employers liability coverage The listed codes of 6702 6703 6704 7151 7152 7153 8734 8737 8738 8805 8814 and 8815 under the Federal Employersrsquo Liability Act (FELA) for employees of interstate railroads are not applicable in the residual market

N This code is part of a ratable non-ratable group shown below The statistical non-ratable code and corresponding rate are applied in addition to the basic classification when determining premium

Class Non-Ratable Code Element Code 4767 0767 4771 0771 7405 7445 7431 7453

P Classification is computed on a per capita basis

X Refer to special classification phraseology in these pages which is applicable in this state

Class Codes with Specific Footnotes

6702 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection code rate and elr each x 1215

6703 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate x 1624 and elr x 1624

6704 Rate and rating values only appropriate for laying or relaying of tracks or maintenance of way - no work on elevated railroads Otherwise assign appropriate construction or erection class rate and elr each x 135

7731 Rate per Service Response

9178 ELR of 704 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 576 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 528 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

9179 ELR of 1448 will be applied to policies in the experience rating period that were effective prior to 112012 As a result of the increase in maximum payroll for this class an ELR of 1185 will be applied to any policies in the experience rating period that were effective between 112012 and 12312012 An ELR of 1086 will be applied to any policies in the experience rating period that were effective 112013 and subsequent

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

37

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 44: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S6

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES

Basis of premium applicable in accordance with Basic Manual footnote instructions for Code 7370 -shyTaxicab Co

Employee operated vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $91700 Leased or rented vehiclehelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Catastrophe (other than Certified Acts of Terrorism) - (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

Expense Constant applicable in accordance with Basic Manual Rule 3-A-11 Excluding Per Capita Codeshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $220 Per Capita Codes Onlyhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $125

Loss Sensitive Rating Plan (LSRP) - The factors which are used in the calculation of the LSRP are as follows

Basic Premium Factor 040 Minimum Premium Factor 075 Maximum Premium Factor 175 Loss Conversion Factor 1171 Tax Multiplier 1031

Loss Development Factors 1st Adjustment 032 2nd Adjustment 023 3rd Adjustment 019 4th Adjustment 016

Maximum Weekly Payroll applicable in accordance with the Basic Manual footnote instructions for Code 9178 -- Athletic Sports or Park Non-Contact Sports and Code 9179 -- Athletic Sports or Park Contact Sportshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

Maximum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $2400

Minimum Weekly Payroll applicable in accordance with Basic Manual Rule 2-E -- Executive Officers or members of limited liability companieshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $1200

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

38

001

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 45: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

WORKERS COMPENSATION AND EMPLOYERS LIABILITY CONNECTICUT Exhibit V Page S7

Effective January 1 2015 APPLICABLE TO ASSIGNED RISK POLICIES ONLY

MISCELLANEOUS VALUES (cont)

Premium Reduction Percentages - The following percentages are applicable by deductible amount and hazard group for total losses on a per claim basis

Total Losses DeductibleAmount

$1000

HAZARD GROUP A B C D E F G 34 25 22 18 14 11 10

$5000 88 68 62 52 43 35 31 $10000 125 100 93 79 66 56 49

Premium Determination for Partners and Sole Proprietors in accordance with Basic Manual Rule 2-E-3 (Annual Payroll)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip $61100

Premium Discount Percentages- (See Basic Manual Rule 3-A-19-a) The following premium discounts are applicable to Standard Premiums

First $10000 -Next $190000 51 Next $1550000 65 Over $1750000 75

Terrorism (Assigned Risk)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip 002

United States Longshore and Harbor Workers Compensation Coverage Percentage applicable only in connection with Basic Manual Rule 3-A-4helliphelliphelliphelliphelliphelliphelliphellip 25

(Multiply a Non-F classification rate by a factor of 125 to adjust for the difference in state and federal benefits only)

Workers Compensation Administration Funds Assessment factors applicable in accordance with the Connecticut State Rule Exception to Basic Manual Rule 3-A-13 (expressed as a percentage of premium)

Industrial Classifications and MaritimeFELA (Program I and Program II State Act)helliphelliphelliphelliphelliphelliphelliphelliphellip F Classifications and MaritimeFELA (Program II USL Act)helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip

16 40

Experience Rating Eligibility A risk is eligible for intrastate experience rating when the payrolls or other exposures developed in the last year or last two years of the experience period produced a premium of at least $11000 If more than two years an average annual premium of at least $5500 is required The Experience Rating Plan Manual should be referenced for the latest approved eligibility amounts by state

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

39

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 46: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING ndash JANUARY 1 2015

NCCI KEY CONTACTS

Laura Backus Hall State Relations Executive Regulatory Services Division

National Council on Compensation Insurance Inc (NCCI) 1493 Maple Hill Road Plainfield VT 05667 Phone 802-454-1800 bull Fax 802-454-1802

James R Davis ACAS MAAA Director and Actuary

Actuarial amp Economic Services Division National Council on Compensation Insurance Inc (NCCI)

901 Peninsula Corporate Circle Boca Raton FL 33487-1362

Phone 561-893-3097 bull Fax 561-893-5185

All NCCI employees can be contacted via e-mail using the following format

First Name_Last NameNCCIcom

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

40

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 47: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

A M C O INSURANCE COMPANY ACADIA INSURANCE COMPANY ACCIDENT FUND GENERAL INS CO ACCIDENT FUND INS CO OF AMERICA ACCIDENT FUND NATIONAL INS CO ACE AMERICAN INSURANCE COMPANY ACE FIRE UNDERWRITERS INSURANCE COMPANY ACE PROPERTY amp CASUALTY INSURANCE COMPANY ACIG INS CO ADMIRAL INDEMNITY COMPANY ADVANTAGE WC INSURANCE CO AIG ASSURANCE COMPANY AIG PROPERTY CASUALTY COMPANY AIOI NISSAY DOWA INS CO OF AMERICA AIU INSURANCE CO (NATIONAL UNION FIRE OF PITTS PA) ALL AMERICA INS CO ALLIED INSURANCE COMPANY OF AMERICA ALLIED PROPERTY AND CASUALTY INS CO ALLMERICA FINANCIAL BENEFIT INS CO AMERICAN ALTERNATIVE INSURANCE CORPORATION AMERICAN AUTOMOBILE INSURANCE CO AMERICAN CASUALTY COMPANY OF READING P A AMERICAN COMPENSATION INS CO AMERICAN ECONOMY INS CO AMERICAN FAMILY HOME INS CO AMERICAN FIRE AND CASUALTY CO AMERICAN GUARANTEE AND LIABILITY INS CO AMERICAN HOME ASSUR CO-NATIONAL UNION FIRE OF PIT AMERICAN INS CO AMERICAN MINING INS CO AMERICAN MODERN HOME INS CO AMERICAN STATES INS CO A SAFECO COMPANY AMERICAN ZURICH INS CO AMERISURE INS CO AMERISURE MUTUAL INS CO AMGUARD INS CO ANSUR AMERICA ARBELLA INDEMNITY INS CO ARBELLA PROTECTION INS CO ARCH INSURANCE COMPANY ARGONAUT GREAT CENTRAL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

41

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 48: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

ARGONAUT INS CO ASSOCIATED EMPLOYERS INS CO ASSOCIATED INDEMNITY CORP ASSOCIATED INDUSTRIES OF MASS MUTUAL INS CO ASSURANCE COMPANY OF AMERICA ATLANTIC SPECIALTY INS CO (ONEBEACON) BANKERS STANDARD INS CO BENCHMARK INSURANCE COMPANY BERKLEY NATIONAL INSURANCE COMPANY BERKLEY REGIONAL INS CO BERKSHIRE HATHAWAY HOMESTATE INS CO BITUMINOUS CASUALTY CORP BLUE RIDGE INDEMNITY COMPANY BROTHERHOOD MUTUAL INS CO CALIFORNIA INSURANCE COMPANY CAPITOL INDEMNITY CORP CAROLINA CASUALTY INS CO CASTLEPOINT NATIONAL INS CO CENTRAL MUTUAL INS CO CHARTER OAK FIRE INS CO CHEROKEE INS CO CHUBB INDEMNITY INS CO CHUBB NATIONAL INS CO CHURCH MUTUAL INS CO CINCINNATI CASUALTY COMPANY CINCINNATI INDEMNITY COMPANY CINCINNATI INS CO CITIZENS INS CO OF AMERICA CLERMONT INS CO COLONIAL AMERICAN CASUALTY amp SURETY CO COMMERCE AND INDUSTRY INS CO COMPANION COMMERCIAL INS CO COMPANION PROPERTY AND CASUALTY INS CO CONTINENTAL CASUALTY CO CONTINENTAL INDEMNITY CO CONTINENTAL INS CO CONTINENTAL WESTERN INSURANCE COMPANY CRUM AND FORSTER INDEMNITY CO DAKOTA TRUCK UNDERWRITERS DEPOSITORS INS CO DISCOVER PROPERTY amp CASUALTY INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

42

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 49: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

EASTGUARD INS CO ELECTRIC INS CO EMCASCO INS CO EMPLOYERS ASSURANCE COMPANY EMPLOYERS FIRE INSURANCE COMPANY EMPLOYERS INS CO OF WAUSAU EMPLOYERS MUTUAL CASUALTY CO EMPLOYERS PREFERRED INS CO EVEREST NATIONAL INS CO EVEREST REINSURANCE CO DIRECT EXCELSIOR INSURANCE COMPANY EXECUTIVE RISK SPECIALTY INS CO FARM FAMILY CASUALTY INS CO FARMINGTON CASUALTY COMPANY FEDERAL INSURANCE COMPANY FEDERATED MUTUAL INS CO FEDERATED SERVICE INS CO FIDELITY amp DEPOSIT COMPANY OF MARYLAND FIDELITY amp GUARANTY INS UNDERWRITERS FIDELITY amp GUARANTY INSURANCE CO FIREMANS FUND INSURANCE CO FIREMENS INS CO OF WASHINGTON DC FIRST LIBERTY INS CORP FIRST NATIONAL INS CO OF AMERICA FIRSTCOMP INSURANCE CO FLORISTS MUTUAL INSURANCE CO FOREMOST INS CO GRAND RAPIDS MICHIGAN FOREMOST PROPERTY amp CAS INS FOREMOST SIGNATURE INS CO FRANK WINSTON CRUM INSURANCE CO FRANKENMUTH MUTUAL INS CO GENERAL CASUALTY COMPANY OF WISCONSIN GENERAL INS CO OF AMERICA GENESIS INS CO GRANITE STATE INSURANCE COMPANY GRAPHIC ARTS MUTUAL INS CO GREAT AMERICAN ALLIANCE INS CO GREAT AMERICAN ASSURANCE COMPANY GREAT AMERICAN INS CO OF NY GREAT AMERICAN INSURANCE COMPANY GREAT AMERICAN SPIRIT INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

43

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 50: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

GREAT DIVIDE INSURANCE COMPANY GREAT NORTHERN INS CO GREAT WEST CASUALTY COMPANY GREATER NY MUTUAL INS CO GREENWICH INS CO GUIDEONE MUTUAL INS CO HANOVER AMERICAN INS CO HANOVER INS CO HARLEYSVILLE INSURANCE COMPANY HARLEYSVILLE PREFERRED INSURANCE CO HARLEYSVILLE WORCESTER INSURANCE CO HARTFORD ACCIDENT AND INDEMNITY CO HARTFORD CASUALTY INS CO HARTFORD FIRE INSURANCE CO HARTFORD INS CO OF IL HARTFORD INS CO OF MIDWEST HARTFORD INS CO OF THE SOUTHEAST HARTFORD UNDERWRITERS INS CO HDI GERLING AMERICA INSURANCE COMPANY ILLINOIS NATIONAL INSURANCE COMPANY IMPERIUM INSURANCE COMPANY INDEMNITY INS CO OF N AMERICA (INA INS) (CT GEN) INS CO OF GREATER NY INS CO OF NORTH AMERICA INS CO OF THE STATE PA INS CO OF THE WEST LIBERTY INS CORP LIBERTY INSURANCE UNDERWRITERS INC LIBERTY MUTUAL FIRE INS CO LIBERTY MUTUAL INS CO LION INSURANCE COMPANY LM INS CORP LUMBERMENS UNDERWRITING ALLIANCE MA BAY INS CO MA HOMELAND INS CO MAIN STREET AMERICA ASSURANCE CO MANUFACTURERS ALLIANCE INS CO MARKEL INSURANCE CO MARYLAND CASUALTY COMPANY ME EMPLOYERS MUTUAL INS CO MEMIC INDEMNITY CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

44

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 51: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

MERIDIAN CITIZENS MUTUAL INSURANCE CO MERIDIAN SECURITY INSURANCE COMPANY MIDDLESEX INS CO MIDVALE INDEMNITY COMPANY MIDWEST EMPLOYERS CASUALTY CO MIDWESTERN INDEMNITY CO MILBANK INSURANCE COMPANY MITSUI SUMITOMO INS CO OF AMERICA MITSUI SUMITOMO INS USA INC MOTORISTS COMMERCIAL MUTUAL INSURANCE COMPANY NATIONAL CASUALTY CO NATIONAL FIRE INS CO OF HARTFORD NATIONAL INTERSTATE INS CO NATIONAL LIABILITY amp FIRE INSURANCE CO NATIONAL SURETY CORP NATIONAL UNION FIRE INS CO OF LA NATIONAL UNION FIRE INS CO OF PITTSBURG PA NATIONWIDE AGRIBUSINESS INS CO NATIONWIDE GENERAL INSURANCE CO NATIONWIDE MUTUAL FIRE INS CO NATIONWIDE MUTUAL INS CO NATIONWIDE PROPERTY AND CASUALTY INS CO NETHERLANDS INSURANCE COMPANY NEW HAMPSHIRE INSURANCE COMPANY NEW YORK MARINE AND GENERAL INSURANCE CO NGM INSURANCE COMPANY NIPPONKOA INS CO LIMITED (US BRANCH) NORGUARD INS CO NORTH AMERICAN SPECIALTY INS CO NORTH POINTE INS CO NORTH RIVER INS CO NORTHERN INSURANCE CO OF N Y NOVA CASUALTY COMPANY OAK RIVER INSURANCE COMPANY OBI NATIONAL INSURANCE COMPANY OH CASUALTY INS CO OHIO SECURITY INS CO OLD REPUBLIC GENERAL INSURANCE CORPORATION OLD REPUBLIC INS CO ONEBEACON AMERICA INS CO ONEBEACON INSURANCE COMPANY

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

45

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 52: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

PA MANUFACTURERS ASSN INS CO PA MANUFACTURERS INDEMNITY CO PACIFIC EMPLOYERS INS CO PACIFIC INDEMNITY CO PACIFIC INS CO LTD PATRIOT GENERAL INS CO PATRONS MUTUAL INS CO OF CT PEERLESS INDEMNITY INS CO PEERLESS INSURANCE COMPANY PENN MILLERS INS CO PENNSYLVANIA INSURANCE COMPANY PETROLEUM CASUALTY CO PHARMACISTS MUTUAL INS CO PHOENIX INS CO PRAETORIAN INSURANCE COMPANY PREFERRED PROFESSIONAL INSURANCE COMPANY PRESERVER INS CO PROPERTY AND CASUALTY INS CO OF HARTFORD PROTECTIVE INS CO PUBLIC SERVICE INSURANCE COMPANY QBE INSURANCE CORPORATION REDWOOD FIRE amp CASUALTY INS CO REGENT INSURANCE COMPANY REPUBLIC FRANKLIN INS CO REPUBLIC INDEMNITY CO OF CA REPUBLIC INDEMNITY COMPANY OF AMERICA REPUBLIC UNDERWRITERS INSURANCE CO RIVERPORT INSURANCE COMPANY RLI INSURANCE COMPANY SAFECO INS CO OF AMERICA SAFETY FIRST INS CO SAFETY NATIONAL CASUALTY CORP SAGAMORE INSURANCE CO SAMSUNG FIRE AND MARINE INS CO LTD USB SECURITY NATIONAL INS CO (AMTRUST GROUP) SELECTIVE INS CO OF SC SELECTIVE INS CO OF THE SOUTHEAST SELECTIVE INSURANCE COMPANY OF AMERICA SELECTIVE WAY INS CO SENECA INSURANCE CO SENTINEL INS CO

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

46

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 53: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

SENTRY CASUALTY CO SENTRY INSURANCE A MUTUAL CO SENTRY SELECT INSURANCE COMPANY SOMPO JAPAN INSURANCE CO OF AMERICA SPARTA INSURANCE COMPANY ST PAUL FIRE AND MARINE INS CO ST PAUL GUARDIAN INS CO ST PAUL MERCURY INS CO ST PAUL PROTECTIVE INS CO STANDARD FIRE INSURANCE COMPANY STAR INS CO STARNET INSURANCE COMPANY STARR INDEMNITY AND LIABILITY CO STATE AUTO PROPERTY AND CASUALTY INS CO STATE AUTOMOBILE MUTUAL INS CO STATE FARM FIRE AND CASUALTY CO STATE NATIONAL INSURANCE COMPANY STONINGTON INS CO STRATHMORE INS CO T H E INSURANCE COMPANY TECHNOLOGY INSURANCE CO THE TRAVELERS CASUALTY COMPANY TNUS INSURANCE CO TOKIO MARINE AMERICA INSURANCE CO TOWER INS CO OF NY TOWER NATIONAL INS CO TRANS PACIFIC INS CO TRANSGUARD INS CO OF AMERICA INC TRANSPORTATION INS CO TRAVELERS CASUALTY amp SURETY CO OF AMERICA TRAVELERS CASUALTY AND SURETY CO TRAVELERS CASUALTY INS CO OF AMERICA TRAVELERS COMMERCIAL INS CO TRAVELERS INDEMNITY CO TRAVELERS INDEMNITY CO OF AMERICA TRAVELERS INDEMNITY CO OF CT TRAVELERS INSURANCE CO TRAVELERS PROPERTY CASUALTY CO OF AMERICA TRI STATE INSURANCE COMPANY OF MINNESOTA TRIUMPHE CASUALTY COMPANY TRUCK INSURANCE EXCHANGE

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

47

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015
Page 54: Voluntary Loss Costs And Assigned Risk Rates … Effective January 1, 2015 The “2014 Connecticut Workers Compensation Voluntary Loss Costs and Assigned ... Actuary for the National

CONNECTICUT

WORKERS COMPENSATION FILING - JANUARY 1 2015

NCCI AFFILIATE LIST

TRUMBULL INS CO TWIN CITY FIRE INS CO UNION INSURANCE COMPANY UNITED STATES FIDELITY AND GUARANTY CO UNITED WI INS CO US FIRE INS CO UTICA MUTUAL INS CO UTICA NATIONAL ASSURANCE CO VALLEY FORGE INS CO VANLINER INS CO VIGILANT INS CO WAUSAU BUSINESS INSURANCE COMPANY WAUSAU UNDERWRITERS INSURANCE COMPANY WESCO INSURANCE COMPANY (AMTRUST GROUP) WEST AMERICAN INS CO WESTCHESTER FIRE INSURANCE COMPANY WESTPORT INSURANCE CORPORATION WORK FIRST CASUALTY CO XL INS CO OF NY INC XL INSURANCE AMERICA INC XL SPECIALTY INS CO ZENITH INS CO ZURICH AMERICAN INS CO ZURICH AMERICAN INS CO OF IL

copy Copyright 2014 National Council on Compensation Insurance Inc All Rights Reserved

48

  • _1 CT Rate Filing 1-1-2015 Cover Pagepdf
  • _2 Filing Letter CT 1-1-2015
  • _3 Actuarial Certification and Disclosures Filing CT 1-1-2015
  • _4 Copyright_Filing_2014
  • _5 Filing ToC CT 1-1-2015
  • _6 Filing minus ToC AR Cover amp KC CT 1-1-2015
  • _7 Advisory Loss Costs
  • _8A AR Cover Page CT 1-1-2015
  • _8B AR From CRS
  • _9 Filing Key Contacts CT 1-1-2015
  • _10 Affiliate List CT 1-1-2015