DEPARTMENT OF INSURANCE

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P & C and Documents

Application for Excess Rates (Consent to Rate)

Application For Excess Rates (Consent To Rate) 1R-1 P&C (6/2024) --

Charitable Health Care

Charitable Health Care Providers Registration --

Checklists- Rate and Form Filing for P&C Companies

Glass (monoline) --

Workers' Compensation --

Travel and Accident --

Title --

Surety (Fidelity, Suretyship and Financial Institution Bonds) --

Stop Loss (Self-Funded Work Comp; Health Plans; HMO & Managed Care; Gen Liab; Prof Liab) --

Service Contract Reimbursement --

Recreational Vehicle --

Professional Liability (non-medical) --

Pollution Legal Liability (environmental impairment liability) --

Personal Umbrella --

Personal Inland Marine --

Personal General Liability and Personal Umbrella/Excess --

Personal Dwelling, Homeowners, Mobile Homeowners and Farmowners including primary residence --

Personal Automobile --

Motorcycle --

Motor Vehicle Extended Warranty Reimbursement Insurance --

Motor Home --

Auto Guaranty --

Aviation --

Boat Owners --

Boiler and Machinery (equipment breakdown) --

Commercial Automobile --

Commercial Farm --

Commercial General Liability --

Commercial Inland Marine --

Commercial Property --

Commercial Umbrella (excess liability) --

Credit (Vendor Single/Dual Interest; Unemployment/Layoff; Collateral Protection; Property; GA) --

Crime --

Crop --

Earthquake (monoline) --

Employment Practices Liability --

Flood (monoline) --

Home Warranty --

Livestock, Equine and Pet --

Medical Professional Liability --

Mortgage Guaranty --

Exempt Insured Certificates per KRS 304.11-020 and 806 KAR 11:010

Exempt Commercial Policy Holder Certification --

Industrial Insured Certification --

Government Entity Certification --

Filing Information

Designation of Medical Malpractice Line --

Explanatory Memo Regarding Low-Speed Electric Vehicles and Golf Carts --

Advisory Opinion 08-04: Form, Rate, and Supplementary Rating Information (Rule) Filings --

Kentucky Assigned Claims Plan

Supplement to No-Fault Application for Benefits --

Kentucky Assigned Claims Plan [

]

Kentucky No-Fault Application for Benefits --

Kentucky Insurance Arbitration Association

Kentucky Insurance Arbitration Association [

]

Liability Self-Insured Groups Rate Rule and Form Filings

Filing Synopsis Form --

Loss Cost Notes --

Face Sheet and Verification Form for Liability Self-Insurance Groups --

Expense Constant Supplement --

Filing Synopsis for Rates and/or Rules --

Forms Index --

Calculation of Loss Cost Multiplier --

E-Mod (Experience Modification) Affidavit --

Medical Malpractice Reports per KRS 304.40-075 and KRS 304.40-310

User guide for online medical malpractice --

Med Mal Claim Form (MMF1 9/2004) --

CHP2A- Medical Professional Liability Insurance Annual Data Call --

CHP-2B- Medical Professional Liability Insurance Annual Data Call --

Mine Subsidence Fund

Insuring Your Property Against Underground Mine Collapse --

Kentucky Mine Subsidence Insurance Fund Plan of Operations --

No-Fault Rejection per KRS 304.39-060

Bulletin 2001-1 --

No Fault Rejection Verification (NFV-1) P&C 9/04 --

Online Manual For No-Fault Rejection Verification Request --

No Fault Rejection Form (NF-1) P&C 12/17 --

Rate, Rule, Form Filings, per 806 KAR 13:150 and 806 KAR 14:006

NAIC Property & Casualty Transmittal Document Instructions --

LC-1&2 P&C Explanatory Notes (9/2004) --

Consumer Information System for Personal Automobile and Homeowner Premium Information --

Order: Consumer Information for Personal Automobile and Homeowner Premium Information (2018)

CPQ-1 P&C 9/2004 Contact Person Questionnaire --

Product Coding Matrix --

LC-2 P&C Expense Constant Supplement (10/2007) --

LC-1 P&C Calculation of Loss Cost Multiplier (10/2007) --

Risk Purchasing Groups KRS 304.45

Appointment for Agent for Service of Process RPG-2 --

Purchasing Group Information - RPG Info --

Application for Registration RPG-1 --

Surplus Lines Broker Documents

Broker eServices Instruction Manual --

Surplus Lines Batch File Affidavit Template - Updated 8/18/2022 --

Workers' Comp Self-Insured Groups Rate Rule and Form Filings

WCSIG S-1 P&C Filing Synopsis For Rates And/Or Rules --

WCSIG LC-2 P&C Calculation Of Loss Cost Multiplier Expense Constant Supplement --

WCSIG LC-1 P&C Calculation Of Loss Cost Multiplier --

WCSIG LC Notes P&C Explanatory Notes --

WCSIG F-1A P&C Face And Verification Form --

WCSIG EMA P&C Affidavit Regarding Calculation Of Experience Modification Factor --

WCSIG S-2 P&C Filing Synopsis For Forms --