About ICRMA » Prospective Members » Request an Indication     Thursday, October 19, 2017

Thank you for your interest in ICRMA. Please contact us if you would like to schedule an appointment to discuss pool membership and benefits in greater detail. We are confident the range of services provided by ICRMA will help your agency manage its claims and control costs.  At no cost to your agency, ICRMA will provide preliminary cost of coverage estimates.  To provide you with pricing, we will need a completed indication request form (see link below) and:

 

Liability Program:

1. Payroll information for the most recent calendar year

2. A loss run in electronic format (Excel is preferred) for the last ten years. The loss run should be valued as of the last day of the previous month. Your agency’s third party claims administrator should provide this report for you, and should include the following for each claim:

     i.    Date of injury

     ii.   Description of the claim

     iii.   Paid and reserve amounts

     iv.   Total incurred

3. Advise what self-insured retention(s) your agency would like to consider. ICRMA members currently select from the following: $100,000, $250,000, $300,000, $400,000, $500,000, $750,000, $1 million, $1.5 million, $5 million

 Workers’ Compensation Program

1. Payroll information for the most recent calendar year

2. A loss run in electronic format (Excel is preferred) for the last ten years. The loss run should be valued as of the last day of the previous month. Your agency’s third party claims administrator should provide this report for you, and include the following for each claim:

         i.  Date of injury

        ii.  Description of the claim

        iii.  Medical paid amounts

        iv.  Indemnity paid amounts

        v.  Reserve amounts

        vi.  Total incurred

3. Advise what self-insured retention(s) the city would like to consider. ICRMA members currently select from the following: $350,000, $500,000, $750,000, $1 million 

Property Program:

 

1. Most current statement of values

Once completed, submit the required data and indication request using the Submit button at the bottom of the form. 

Your agency is invited to apply for membership in all ICRMA programs, but at minimum, must join either the Liability or Workers’ Compensation Program. If your agency elects to pursue membership after reviewing the cost indication, it will be required to complete Membership Application(s) which require more explicit and detailed underwriting information. These applications are then submitted to ICRMA’s broker and insurance carriers. There is a $1,000 non-refundable processing fee to cover the costs of underwriting and the actuarial evaluation. If your agency is admitted for membership, this fee will be applied as a credit against the agency’s first invoice.

 

If you have any questions, please contact ICRMA staff at (714) 426-8503. Thank you again for your interest in ICRMA.

 

Indication Request Form

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