FEDERAL SHARE CLAIM PROCESS
forms
There are five (5) forms that must be completed for Federal
share requests to be considered and processed. Separate forms
must be provided for each Program Year. Links are provided
here to the hardcopy versions of the forms which can be downloaded.
However, the expectation is that most insurers will use the
electronic versions that will be available through the Facility.
The electronic forms are designed with drop down menus, help
screens and built in edits. If an insurer is a member
of an affiliated group, the group must select one insurer
to submit forms on behalf of the group.
1. Initial
Notice of Insured Loss (INL) 
– This form provides insurer contact information and
initial estimates of insured losses to assist Treasury in
projecting funding levels necessary to provide the Federal
share. It must be submitted to Treasury when estimated incurred
aggregate insured losses (including reserves for “incurred
but not reported”) for an insurer, or collectively for
a group of affiliated insurers, exceed an amount equal to
50 percent of the Program Year insurer deductible.
2. Certification
of Loss (COL)
– This form provides Treasury with the information that
substantiates an insurer’s claim for the Federal share
of compensation. It must be certified and submitted by a designated
officer of the insurer/group. The COL is supported by Schedules
A, B, and C. After the initial COL, supplementary COLs may
be submitted for any one Program Year.
3. Schedule
A
– Direct Earned Premium and Insurer Deductible –
This form has been designed to calculate a company/group’s
Program Year deductible under TRIA. It must be completed,
certified by a designated officer of the insurer/group, and
submitted to Treasury with the Initial Certification of Loss
(COL) or at the insurer’s option, with the Initial Notice
of Insured Loss (INL). The deductible is calculated by using
the company/group’s direct earned premium for the year
preceding the Program Year for which losses are being submitted
(most cases). See the form instructions and regulations, including
instructions for insurers coming into existence after November
26, 2002. Schedule A must be submitted once for each Program
Year affected.
4. Schedule
B
– Certification of Compliance with Section 103(b) of
Terrorism Risk Insurance Act of 2002 - The Schedule B form
contains certifications that the insurer/group has complied
with the requirements of TRIA and the regulations and therefore
is eligible to receive the Federal share of compensation.
It must be completed, certified by a designated officer of
the insurer/group, and submitted to Treasury with each Certification
of Loss (COL).
5. Schedule C – Bordereau
and Instructions
- The purpose of the Bordereau is to provide the necessary
underlying claim information that supports each Certification
of Loss (COL). It must be certified and submitted to Treasury
by a designated officer of the insurer/group, with each Certification
of Loss (COL). The Facility will provide the means for an
insurer to enter individual underlying claim information and
create the bordereau. This may be appropriate in cases where
there are relatively few underlying claims to report. To handle
bordereaux with larger numbers of underlying claims, an insurer
will be able to upload a bordereau through the Facility.
There are 3 standard formats allowed for the Schedule
C (Bordereau) uploads.
1. EXCEL
An Excel file based on the format provided in the following
link. Schedule
C Excel template .
Please make sure that the fields in the Excel file being uploaded
are in the exact same format as in the template provided.
2. CSV
A comma delimited text file, or .csv, with all the fields
defined for the bordereau. Each field has to be included in
the exact same sequence as defined in the above Excel template
(or the order of the fields defined in the Schedule
C
instructions) even if there are no data for that column.
3. PIPE DELIMITED
A pipe delimited text file, where columns are separated with
the "|" symbol, with all the fields defined for
the bordereau. Each field has to be included in the exact
same sequence as defined in the above Excel template (or the
order of the fields defined in the Schedule
C
instructions) even if there are no data for that column.
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Last Updated:
January 19, 2007
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