Ill. Admin. Code tit. 50, pt. 939, ILLUSTRATION B

Current through Register Vol. 48, No. 49, December 6, 2024

Policies Covering Physicians and Surgeons-Reserves

Year In Which Losses Were Incurred								Losses Unpaid On Reported Claims
	As of								Difference
a) 12/31/84,			b) 12/31/85,					(b) - a)
Prior to 1978	_______				_______				___________
1978	_______				_______				___________
1979	_______				_______				___________
1980	_______				_______				___________
1981	_______				_______				___________
1982	_______				_______				___________
1983	_______				_______				___________
1984	_______				_______				___________
1985	___x___								______x_____
______________________________________________________
TOTALS	_______				_______				___________

Year In Which Losses Were Incurred								Losses Unpaid On Incurred But Not Reported Claims
	As of								Difference
a) 12/31/84,			b) 12/31/85,					(b) - a)
Prior to 1978	_______				_______				___________
1978	_______				_______				___________
1979	_______				_______				___________
1980	_______				_______				___________
1981	_______				_______				___________
1982	_______				_______				___________
1983	_______				_______				___________
1984	_______				_______				___________
1985	___x___								______x_____
______________________________________________________
TOTALS	_______				_______				___________

Year In Which Losses Were Incurred								Other Unpaid Losses
	As of								Difference
a) 12/31/84,			b) 12/31/85,					(b) - a)
Prior to 1978	_______				_______				___________
1978	_______				_______				___________
1979	_______				_______				___________
1980	_______				_______				___________
1981	_______				_______				___________
1982	_______				_______				___________
1983	_______				_______				___________
1984	_______				_______				___________
1985	___x___								______x_____
______________________________________________________
TOTALS	_______				_______				___________

General Instructions

_____________________________________________________________

The above information is due on June 1, 1986 and on June 1 every year thereafter as may be required by the Director. For subsequent due dates of June 1, 1987, June 1, 1988 etc., all years shown in this Illustration should be advanced by one, two etc.

Ill. Admin. Code tit. 50, pt. 939, ILLUSTRATION B

Amended at 17 Ill. Reg. 15838, effective September 14, 1993