PENNSYLVANIA FILING FORMS FOR LOSS COST MULTIPLIER

Carriers wishing to establish or revise a loss cost multiplier for use in writing Pennsylvania workers compensation insurance are required to file their proposed multiplier, together with certain specified supporting information, with the Pennsylvania Insurance Department. The Insurance Department requires use of standard forms in supplying the required supporting information for such carrier filings.

The Excel spreadsheet file presented below is an electronic version of the Insurance Department's required loss cost multiplier forms. It may be accessed by clicking on the diskette icon or the underlined text immediately below that icon. That action will allow you to download the file.

 
PENNSYLVANIA FILING FORMS FOR LOSS COST MULTIPLIER

Carriers are strongly encouraged to prepare their loss cost multiplier filing(s) using this spreadsheet file. When completed, the forms may be submitted to the Insurance Department at the following internet address:

ra-rateform@state.pa.us

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