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Froogle 1.1.1.7
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Froogled By:
Elias Makere, FSA, MAAA
Last Froogled:

ASOP 5 | Commentary Section 3.3 | COMMENT ON SECTION 3.3

Section 3.3.1, Unpaid Claims Liability
CommentResponse
One commentator suggested removing “purpose or use of the unpaid claim estimate” from the list.The reviewers believe the current discussion is appropriate and did not make this change because different estimates may be appropriate depending on the intended use.
One commentator suggested adding “as appropriate” after “using incurral and processing dates.”The reviewers agree this improves clarity and made the change.
Section 3.3.1(f), Consistency of Bases (now titled “Consistency of Assumptions and Methodology”)
CommentResponse
One commentator suggesting adding a caveat to address situations when, for example, a consulting actuary’s review is limited to the unpaid claims liabilities reserve.The reviewers believe the use of consistent assumptions and methodology are also appropriate in this situation and made no change.
One commentator suggested clarifying the meaning of “bases” and “related liabilities and reserves.”To improve clarity of meaning, the reviewers changed consistent basis to consistent assumptions and methodology, and included the example of claim settlement expense reserves.
Section 3.3.2, Categories of Incurred Claims
CommentResponse
Several commentators suggested adding detail specific to certain estimation methods, for example considerations regarding categories of incurred claims that would be specific to the development method.The reviewers note that this section is intentionally broad because of the variety of estimation methods in use, and made changes intended to clarify this point.
Section 3.3.4, Large Claims
CommentResponse
One commentator suggested noting that large claims could result in an understatement.The reviewers believe overstatement is an appropriate example in this context and did not make this change.
Section 3.3.5, Coordination of Benefits (COB), Subrogation, and Government Programs
CommentResponse
One commentator noted that section 3.21. uses “reasonable effort.”The reviewers agree that there is not intended to be a difference in the meaning and added “reasonable effort.”
Section 3.3.6, Provider Contractual Arrangements
CommentResponse
Two commentators requested clarity on the definitions of “material” and “disclosure.”The reviewers note that materiality is defined in ASOP No. 1, Introductory Standard of Practice, and that section 4 of this standard refers to disclosure in an actuarial communication.
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