DEPARTMENT OF INSURANCE

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P & C and Documents

General Information (Property and Casualty)

ACORD 25 Announcement - 111K

Charitable Health Care

Charitable Health Care Providers Registration - 12K

Checklists- Rate and Form Filing for P&C Companies

Commercial Property - 75K

Personal Umbrella - 80K

Personal Inland Marine - 81K

Personal General Liability and Personal Umbrella/Excess - 80K

Workers' Compensation - 87K

Travel and Accident - 92K

Title - 64K

Surety (Fidelity, Suretyship and Financial Institution Bonds) - 200K

Stop Loss (Self-Funded Work Comp; Health Plans; HMO & Managed Care; Gen Liab; Prof Liab) - 87K

Service Contract Reimbursement - 82K

Recreational Vehicle - 81K

Professional Liability (non-medical) - 85K

Auto Guaranty - 77K

Aviation - 76K

Boat Owners - 75K

Boiler and Machinery (equipment breakdown) - 71K

Commercial Automobile - 252K

Commercial Farm - 79K

Commercial General Liability - 69K

Commercial Inland Marine - 79K

Pollution Legal Liability (environmental impairment liability) - 82K

Commercial Umbrella (excess liability) - 70K

Credit (Vendor Single/Dual Interest; Unemployment/Layoff; Collateral Protection; Property; GA) - 92K

Crime - 87K

Crop - 87K

Earthquake (monoline) - 80K

Employment Practices Liability - 88K

Flood (monoline) - 86K

Glass (monoline) - 84K

Home Warranty - 77K

Livestock, Equine and Pet - 86K

Medical Professional Liability - 87K

Mortgage Guaranty - 74K

Motor Home - 262K

Motor Vehicle Extended Warranty Reimbursement Insurance - 85K

Motorcycle - 244K

Personal Automobile - 244K

Personal Dwelling, Homeowners, Mobile Homeowners and Farmowners including primary residence - 176K

Excess Rates per 806 KAR 13:020

Application For Excess Rates (Consent To Rate) 1R-1 P&C (9/2004) - 20K

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

Exempt Commercial Policy Holder Certification - 68K

Government Entity Certification - 29K

Industrial Insured Certification - 28K

Filing Information

Information for Newly Admitted Companies - 94K

Designation of Medical Malpractice Line - 96K

Guidelines for Blank Endorsements - 77K

Explanatory Memo Regarding Low-Speed Electric Vehicles and Golf Carts - 44K

Advisory Opinion 08-04: Form, Rate, and Supplementary Rating Information (Rule) Filings - 177K

Kentucky Assigned Claims Plan

Kentucky No-Fault Application for Benefits - 1M

Kentucky Assigned Claims Plan [

]

Supplement to No-Fault Application for Benefits - 11K

Kentucky Insurance Arbitration Association

Kentucky Insurance Arbitration Association [

]

Liability Self-Insured Groups Rate Rule and Form Filings

Filing Synopsis for Rates and/or Rules - 59K

Face Sheet and Verification Form for Liability Self-Insurance Groups - 34K

Loss Cost Notes - 90K

Filing Synopsis Form - 56K

Calculation of Loss Cost Multiplier - 83K

Expense Constant Supplement - 83K

E-Mod (Experience Modification) Affidavit - 7K

Forms Index - 21K

Mandatory Electronic Motor Vehicle Insurance Reporting

Kentucky Mandatory Motor Vehicle Liability Insurance Electronic Reporting Enrollment Information Form - 11K

Mandatory Motor Vehicle Insurance Reporting to the Department of Motor Vehicle Regulations - 69K

KRS 186A.042 - Prohibition against licensing of personal motor vehicles without listing of vehicle identification numbers - Exceptions - 8K

KRS 304.39-085 - Notification by insurance company to Department of Vehicle Regulation of people insured whose policy was terminated - Exceptions - 8K

Kentucky Transportation Cabinet - Automobile Liability Insurance Reporting Guide - 85K

Insurance Binder Cancellation Form - 17K

KRS 304.39-087 - Definition - Submission of vehicle identification numbers and names of policyholders to Department of Vehicle Regulation - Limitation of liability - 8K

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

User guide for online medical malpractice - 765K

Med Mal Claim Form (MMF1 9/2004) - 20K

CHP2A- Medical Professional Liability Insurance Annual Data Call - 44K

CHP-2B- Medical Professional Liability Insurance Annual Data Call - 136K

Mine Subsidence Fund

Insuring Your Property Against Underground Mine Collapse - 1M

Mine Subsidence Eservices User Guide - 1M

Kentucky Mine Subsidence Insurance Fund Plan of Operations - 268K

No-Fault Rejection per KRS 304.39-060

Bulletin 2001-1 - 47K

Online Manual For No-Fault Rejection Verification Request - 1M

No Fault Rejection Form (NF-1) P&C 12/17 - 103K

No Fault Rejection Verification (NFV-1) P&C 9/04 - 8K

Open Records Requests

Open Records Request Form ORR-1 P&C - 72K

Public Access Insurance Filings for Rate, Rule and Form Filing Search - 354K

P&C Types of Insurance - 13K

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

NAIC Property & Casualty Transmittal Document Instructions - 165K

Product Coding Matrix - 243K

NAIC Property & Casualty Form Filing Schedule - 57K

NAIC Property & Casualty Additional Rate/Rule Filing Attachment - 79K

LC-1&2 P&C Explanatory Notes (9/2004) - 17K

Consumer Information System for Personal Automobile and Homeowner Premium Information - 343K

CPQ-1 P&C 9/2004 Contact Person Questionnaire - 85K

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

Memorandum: Premium Surcharge Rate Adjustment - 72K

Clarification of Bulletin 2010-02 Premium Surcharge Rate Adjustment - 86K

NAIC Property & Casualty Rate/Rule Filing Schedule - 54K

LC-2 P&C Expense Constant Supplement (10/2007) - 33K

NAIC Property & Casualty Transmittal Document - 606K

LC-1 P&C Calculation of Loss Cost Multiplier (10/2007) - 103K

Risk Purchasing Groups KRS 304.45

Purchasing Group Information - RPG Info - 112K

Application for Registration RPG-1 - 12K

Appointment for Agent for Service of Process RPG-2 - 49K

Surplus Lines Carrier Documents

Surplus Lines Carrier Filing Requirements for Kentucky (Revised 01/2005) - 135K

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

WCSIG S-1 P&C Filing Synopsis For Rates And/Or Rules - 9K

WCSIG F-1 P&C Forms Index Sheet - 11K

WCSIG EMA P&C Affidavit Regarding Calculation Of Experience Modification Factor - 11K

WCSIG LC-2 P&C Calculation Of Loss Cost Multiplier Expense Constant Supplement - 9K

WCSIG LC-1 P&C Calculation Of Loss Cost Multiplier - 9K

WCSIG LC Notes P&C Explanatory Notes - 16K

WCSIG F-1A P&C Face And Verification Form - 23K

WCSIG S-2 P&C Filing Synopsis For Forms - 11K

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