Attachment J - AIG Loss Run.pdf

484 KB Posted

Attached to
Public Officials Liability Insurance
Solicitation number
RFB 758 2200000252 3
Issued by
Elliott County, Kentucky

About this file

Written by GovTribe AI ·

This is an AIG Loss Run report documenting workers' compensation insurance claims history across three Kentucky workers' compensation policies. The report was generated on October 5, 2021, with a valuation date of October 4, 2021, and covers three policy periods: Policy 0025819790-029-000 (12/31/2018 - 12/31/2019), Policy 0027780748-029-000 (12/31/2016 - 12/31/2017), and Policy 0034178128-029-000 (12/31/2017 - 12/31/2018). The document serves as a detailed claims and financial information report for authorized representatives of the insured entity.

All three Kentucky workers' compensation policies show zero claims recorded during their respective coverage periods, with no loss payments made against any of the policies. The claim count for each policy is zero, indicating a clean loss history with no reportable incidents or claims activity across the coverage periods reviewed.

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Other files

File Type Posted
Attachment A - RFB 758 2200000252-1 - 11-03-2021.pdf PDF
Attachment C - How to Respond to an Online Bid through the Kentucky Vendor Self Service site.pdf PDF
Attachment K - KWCFC FY21 Audited Financial Statements.pdf PDF
Attachment E - Bidder Information Sheet.pdf PDF
Final_RFB_758_2200000252_3_SO_FORM.PDF PDF
Attachment D - Detailed Requirements.pdf PDF
Attachment F - Bid Quotation Form 1.pdf PDF
Attachment A - RFB 758 2200000252-2 -11-08-2021.pdf PDF
Attachment A - RFB 758 2200000252-3 - 11-15-2021.pdf PDF
Attachment B - Annual Affidavit and Other Affidavits.pdf PDF
Attachment G - Bid Specifications Deviation Form 1A.pdf PDF
Attachment I - Loss Run - 10052021.pdf PDF
Attachment H - Bid Specification Enhancement Form 1B.pdf PDF
Final_RFB_758_2200000252_2_SO_FORM.PDF PDF
Final_RFB_758_2200000252_1_SO_FORM.PDF PDF
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AIG Loss Run

Policy : 0027780748-029-000 KENTUCKY WORKERS' COMPENSATION

0034178128-029-000 KENTUCKY WORKERS' COMPENSATION

0025819790-029-000 KENTUCKY WORKERS' COMPENSATION

Filters: Status = ALL Requester ID: 098850 Report Date / Time: 10/05/2021 14:52 EST Valuation Date: 10/04/2021 Source: US/CA

The AIG Loss Run is a detail report, providing claim and financial information.

Run additional reports using IntelliRisk at https://aig.com/ir.

Certain claim information may not be available in this report, since data availability can vary based on the insurance program or benefit state (due to regulatory considerations).

The content contained in this report is subject to privacy and security laws and should be handled in accordance with the applicable laws and regulations. This report is intended for review and use by authorized representatives of the insured or other parties authorized by the insured solely for legitimate business reasons. The information contained herein should be treated as privileged and confidential.

If you are not the intended recipient, you are hereby notified that any disclosure, copy or distribution of this information is strictly prohibited, as is the taking of any action by you in reliance on its contents.

If you received this communication in error, please notify us immediately.

AIG | IntelliRisk Services PAGE: 1 866-893-2520 intellirisk@aig.com

PAGE: 2

Financial Lines Claims

Policy : POL 0025819790-029-000 KENTUCKY WORKERS' COMPENSATION 12/31/2018 - 12/31/2019 Report Date / Time: 10/05/2021 14:52 EST Valuation Date: 10/04/2021 Currency: USD

Claimant Name Div / H.O.

Claim # / OneClaim # Loss State Status Adjuster Name Loss Date Receipt Date Closed Date Manager Name Loss Description Loss Paid

005/ / No Claims for Policy 0025819790-029-000 / Criteria

.00

Pol-Asco-Mod: 0025819790-029-000 Claim Count = 0 .00

PAGE: 3

Financial Lines Claims

Policy : POL 0027780748-029-000 KENTUCKY WORKERS' COMPENSATION 12/31/2016 - 12/31/2017 Report Date / Time: 10/05/2021 14:52 EST Valuation Date: 10/04/2021 Currency: USD

Claimant Name Div / H.O.

Claim # / OneClaim # Loss State Status Adjuster Name Loss Date Receipt Date Closed Date Manager Name Loss Description Loss Paid

005/ / No Claims for Policy 0027780748-029-000 / Criteria

Pol-Asco-Mod: 0027780748-029-000 Claim Count = 0 .00

PAGE: 4

Financial Lines Claims

Policy : POL 0034178128-029-000 KENTUCKY WORKERS' COMPENSATION 12/31/2017 - 12/31/2018 Report Date / Time: 10/05/2021 14:52 EST Valuation Date: 10/04/2021 Currency: USD

Claimant Name Div / H.O.

Claim # / OneClaim # Loss State Status Adjuster Name Loss Date Receipt Date Closed Date Manager Name Loss Description Loss Paid

005/ / No Claims for Policy 0034178128-029-000 / Criteria

Pol-Asco-Mod: 0034178128-029-000 Claim Count = 0 .00

File details come from the government source that posted it. Updated .