6-NCCI Workers Comp Form Rate (Example).pdf
PDF 219 KB Posted
- Solicitation number
- 4063
- Issued by
- Upton County, Amarillo City, Texas
About this file
This is an NCCI Workers Compensation Experience Rating form for a company identified as Risk ID 4211, effective June 1, 2023. The document provides an experience modification rating (EMR) analysis for workers compensation insurance purposes in Texas, analyzing risk classifications TX-A through TX-E. The rating reflects expected losses, actual losses, excess losses, and primary losses across multiple classification codes, with a final experience modification factor of 0.84, indicating a 16% credit applied to the company's workers compensation premium. The form documents that the rating reflects a 70% decrease in medical-only primary and excess loss dollars where ERA (Experience Rating Adjustment) is applied.
The document is an underwriting and premium calculation tool provided by the National Council on Compensation Insurance, Inc. (NCCI) and is expressly restricted for use only for insurance underwriting and premium calculation purposes. The form explicitly prohibits use for safety scoring for project bidding purposes. The experience modification rating of 0.84 suggests the company has a favorable loss history compared to industry averages, which may be relevant context for the Amarillo ISD roofing and HVAC replacement project (CSP 4063) if this company is bidding on the construction contract with a deadline of February 20, 2026. The data presented is current as of the production date of March 6, 2023.
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Text version
NCCI Example EMR Rating
WORKERS COMPENSATION EXPERIENCE RATING
Risk Name: Company Name Risk ID: 4211
Rating Effective Date: 06/01/2023 Production Date: 03/06/2023 State: TEXAS
State Wt Exp Excess Losses
Expected Losses
Exp Prim Losses
Act Exc Losses Ballast Act Inc Losses Act Prim Losses
TX-A .13 73,951 116,029 42,078 2,471 34,475 32,413 29,942
TX-B .13 24 38 14 0 34,475 0 0
TX-C .13 642 1,003 361 0 34,475 0 0
TX-D .13 654 1,022 368 0 34,475 0 0
TX-E .13 700 1,094 394 0 34,475 0 0
(A) Wt
(B) (C) Exp Excess Losses (D - E)
(D) Expected Losses
(E) Exp Prim Losses
(F) Act Exc Losses (H - I)
(G) Ballast (H) Act Inc Losses
(I) Act Prim Losses
.13 75,971 119,186 43,215 2,471 34,475 30,918 28,447
Primary Losses Stabilizing Value Ratable Excess Totals
Actual
(I)
28,447
C * (1 - A) + G
100,570
(A) * (F)
(J)
129,338
Expected
(E)
43,215
C * (1 - A) + G
100,570
(A) * (C)
9,876
(K)
153,661 ARAP FLARAP SARAP MAARAP Exp Mod
Factors
(J) / (K) .84
RATING REFLECTS A DECREASE OF 70% MEDICAL ONLY PRIMARY AND EXCESS
LOSS DOLLARS WHERE ERA IS APPLIED.
© Copyright 1993-2023, All rights reserved. This product is comprised of compilations and information which are the proprietary and exclusive property of the National Council on Compensation Insurance, Inc. (NCCI). No further use, dissemination, sale, transfer, assignment or disposition of this product, in whole or in part, may be made without the prior written consent of NCCI. This product is furnished “As is” “As available” “With all defects” and includes information available at the time of publication only. NCCI makes no representations or warranties of any kind relating to the product and hereby expressly disclaims any and all express, statutory, or implied warranties, including the implied warranty of merchantability, fitness for a particular purpose, accuracy, completeness, correctness, or correctness of the product or information contained therein. This product and the information contained therein are to be used exclusively for underwriting, premium calculation and other Insurance purposes and may not be used for any other purpose including but not limited to safety scoring for project bidding purposes. All responsibility for the use of and for any and all results derived or obtained through the use of the product and information are the end user’s and NCCI shall not have any liability thereto.
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