Request for Separate Experience Data
A Request for Ownership Information (ERM-14 Form) is submitted to NCCI when a change in ownership occurs. Changes in ownership interest may affect the use of an entity’s experience in future experience rating modifications. When an ownership determination is made, NCCI may request exposure and claim information for an individual employer. The Request for Separate Experience Data form will be sent to the data provider for the policy term being requested. The Request for Separate Experience Data is sent when payroll and loss information for the separated employer is comingled with another.
- Employer sells a portion of their operations or a subset of locations
- Employers were covered under a single policy but have undergone a change in ownership and no longer share common majority ownership
- Employers were covered under a single policy but do not have common majority ownership
The following is a sample of the ownership ruling letter and the Request for Separate Experience Data.
Request for Separate Experience Data – Sample (PDF)
NCCI recommends that when separate experience data is requested by NCCI, the data should be reported using the Electronic Data Files method.
Refer to the Experience Rating (ER) Split Data Reporting Guide, Part 2-E, for additional information.