Group/Company Name: ________________________________
Workers´ Compensation Revised Relativities
Notice of Carrier Intent
Page 1
Notice of Carrier Intent
- 1: We adopt the revised 1/1/99 relativities as contained in Commissioner´s Order No. 98-0998 with an effective date of _________________________, by dividing our current deviation by 0.700 and applying the quotient to the new set of relativities. See instructions.
- 2: We adopt the revised 1/1/99 relativities as contained in Commissioner´s Order No. 98-0998 with an effective date of _______________________, and will adjust our rate deviation solely to offset the off-balance created by going from the 1/1/97 Relativities to the 1/1/99 Relativities based on our own distribution of business by classification. See instructions.
- 3: We adopt the revised 1/1/99 relativities as contained in Commissioner´s Order No. 98-0998 with an effective date of _______________________, without any change to our current deviation. See instructions.
- 4: We adopt the revised 1/1/99 relativities as contained in Commissioner´s Order No. 98-0998, with an effective date of _______________________, and change our current deviation resulting in an overall rate level change.
- 5: We are filing our own individually developed set of relativities specific to our company with an effective date of _________________________.