Welcome !

1. Welcome! Residual Market Audit Services NJ AIRE Compliance Audit Program Mark LoVuolo, AIS, API Jack O’Keefe

2. What is AIPSO?

3. AIPSO is… • A management organization and service provider for the residual market with a home office in Johnston, RI • A non-profit organization • A national organization of about 400 employees • An organization with 10 regional offices located throughout the country • An organization that uses a team management approach

4. AIPSO’s Mission AIPSO’s mission is to provide high quality services for the automobile insurance residual market at the lowest possible cost. AIPSO will build on its successes as a leader in helping manage the automobile insurance residual market. We will continually rise to the challenge of being a national organization that serves local customer needs. We will remain flexible and will proactively meet the needs of our divergent customer groups at both national and state levels.

5. “Who is Residual Market Audit Services” (RMAS) ‘ 14 Members of our RMAS staff 1 – Certified Internal Auditor (CIA) 1 – CIAcandidate 2 – Certified Property & Casualty Underwriters (CPCU) 2 – pursuing INS or CPCU designations 1 – 30+ years of Claims Experience 30 – Independent Consultants

6. What Does RMAS Do? • Provide on-site audits of companies for automobile insurance market mechanisms.

7. Purpose of RMAS To support Board of Directors (Governing Boards) in their management of Residual Market Automobile Programs

8. Purpose of Audits Audits are a management tool to ensure companies are handling and reporting policies and claims in compliance with a mechanism’s plan of operations.

9. Objective of NJAIRE Audits To ensure that companies are submitting complete and accurate data to the NJAIRE. Compliance - Data reported meets specifications in the Plan of Operations. Operational – Company’s internal controls are effective in processing and identifying NJAIRE business.

10. Audit Process Stage 1: Planning • Company Selection • Communication with ISO • Call Forms • Statement of Compliance • Concerns with Companies

11. Audit Process Stage 1: Planning (con’t) c. Engagement Letter – Includes request for data • All private passenger BI claims • All reportable claims • All other claims d. Company contact information received

12. Audit Process Stage 1: Planning (con’t) • Receipt of company data • Verification of data to call forms • Complete sample selections • h. Confirmation Letter

13. Audit Process Stage 2: Fieldwork • Opening meeting • b. Obtain internal procedures for reviewing data submissions • c. File review • Determination Forms

16. Audit Process • Stage 2: Fieldwork • File review (con’t) • Workpapers

18. Audit Process • Stage 2: Fieldwork • Fieldwork summary • Closing meeting

19. Audit Process Stage 3: Reporting 1. Draft Report 2. Company’s Response 3. Final Report

20. 2003 - 2005 Audits (32 Companies Reviewed) Reportable Claims • Total files reviewed – 1,749 • Number of Claimants Over Reported – 323 or 18.5% • Dollar Amount Over Reported - $4,627,210

21. 2003 - 2005 Audits Reasons for Over Reporting: • Claimant or Insured Incorrect Threshold • Unverified Claimant Threshold • These two reasons account for 52% of reporting errors

22. Additional Reasons for Over Reporting • Economic Loss Payment Included • Claimant had pierced the threshold • Claimant was not a NJ Resident • Claim Occurred outside of NJ • Expense Payments Included in Reporting • Insured Vehicle was Commercial

23. Reporting Errors • Incorrect Territory Codes • Settlement Reported in an Incorrect Quarter or Year • Over Reporting of the Dollar Amount

24. 2003 – 2005 Audits(32 Companies Reviewed) All Bodily Injury Claims: • Total files reviewed – 2,562 • Number of Claimants Under Reported – 107 or 4% • Dollar Amount Under Reported - $958,012

25. Reasons for Under Reporting • Claimant had a Zero Dollar Threshold • Insured had a Verbal Threshold • Unverified Claimant Threshold

26. Reporting Errors • Non Bodily Injury Paid Claims • Bodily Injury Claims with No Payment • Incorrect Territory Codes • File not Settled in Reporting Year • Settlement reported in Incorrect Quarter • Incorrect Insured Threshold • Commercial Bodily Injury Claims Paid

27. TIPS • Plant your corn early • “Easy Sleazy” in the third race at Monmouth Park • Don’t say “Hi Jack” if you see me at the airport

28. NJAIRE Claim Handling TIPS • Claims handlers should be familiar with the NJAIRE procedure manual – NJAIRE.org • Know the requirements for verification of the claimant’s threshold (Pgs 29 –30 of the procedure manual) • Use the NJAIRE recommended Claim Determination Form • Check the final determination after claim is settled and before it is submitted to IT

29. QUESTIONS? • What? Huh? • ? • What does it all mean? • ?

30. Thank you! Residual Market Audit Services NJAIRE Compliance Audit Program Mark LoVuolo, AIS, API Jack O’Keefe