Adobe Acrobat Reader is required to view some of the documents on the Annual Statement Notice. A free copy of the Reader may be downloaded from the Adobe website.

Please be advised that there have been changes to these instructions from the prior year. Read this notice and all referenced instructions, checklists and notes carefully before proceeding with the filing.

 
This notice contains instructions for filing the 2013 Annual Statement with the Commonwealth of Massachusetts, Division of Insurance.  Unless otherwise indicated, all filings must comply with 2013 NAIC Annual Statement Instructions for your type of company, including any required quarterly filings; and the NAIC’s Accounting Practices and Procedures Manual.

For any questions or information regarding filing with the NAIC, the 2013 NAIC Annual Statement Instructions, or the NAIC's Accounting Practices and Procedures Manual, please refer to the NAIC website.
The required checklist for each company type specifies the filing dates for all required filings with the Commonwealth of Massachusetts.  All schedules must be securely attached to the appropriate pages or bound separately. 

All required Annual Statements must be subscribed and sworn before a notary by at least two principal officers of the company.


Company Renewal and Filing Fees


 

LICENSE RENEWAL & FILING FEE PAYMENT MAILING ADDRESS


 

Checks are to be made payable to the Commonwealth of Massachusetts Division of Insurance and mailed with a completed Lock Box Form pdf format of Lock Box Form
and License Renewal Application pdf format of Renewal Application - Foreign Company License...
(if applicable) to:

Division of Insurance
Annual Statement Filing / Company License Renewal
P.O. Box 370039
Boston, MA 02241-0739


 

ANNUAL STATEMENT MAILING ADDRESS


 
This address is to be used for mailing all items except payments, lock box forms, and license renewal applications.

Commonwealth of Massachusetts
Division of Insurance
Financial Surveillance Section
1000 Washington St, Suite 810
Boston, MA 02118-6200

 

PENALTY


 

M.G.L. Chapter 175, Section 26, provides for a penalty of $100 per day if the Annual Statement, and all other related filings, are not received in the proper form and by the date required. In addition, any company that neglects to file in the proper form, and by the date required, may be required to cease writing new business as long as the filing deficiency continues.

 



REINSURANCE CREDIT


 
Credit for reinsurance must be recorded in accordance with the provisions of M.G.L. Chapter 175, Section 20A. For a list of Licensed and/or Approved Companies in Adobe click here pdf format of LicensedOrApprovedCompanies_A.pdf
, for Microsoft Excel click here xls format of LicensedOrApprovedCompanies_A.xls
.

 


CERTIFICATES OF COMPLIANCE


 

Domestic Insurance Companies that would like to request Certificates of Compliance pdf format of request.PDF
to be effective January 1, 2014 should mail their request to Ursula McCarthy at the Annual Statement Mailing Address.
 

 



WORKERS' COMPENSATION SCHEDULE C-1 and WORKERS' COMPENSATION DEPOSITS


 

All foreign insurers authorized for Workers' Compensation in Massachusetts that have an AM Best rating of "A-" or higher are not required to file a Workers' Compensation Schedule C-1 and are not required to maintain a Workers' Compensation deposit in accordance with the calculation in the Workers' Compensation Schedule C-1. The required Workers' Compensation deposit for these companies is $50,000.00.

All foreign insurers authorized for Workers' Compensation in Massachusetts that have an AM Best rating of "B++"or lower are required to file a Workers' Compensation Schedule C-1 and are required to maintain a Workers' Compensation deposit in accordance with the calculations in the Workers' Compensation Schedule C-1.