| Reserve for Losses and Loss Adjustment Expenses | Reserve for Losses and Loss Adjustment Expenses The reserve for losses is established based on estimates of individual claims and actuarially determined estimates of future losses based on ProAssurance’s past loss experience, available industry data and projections as to future claims frequency, severity, inflationary trends and settlement patterns. Estimating the reserve, particularly the reserve appropriate for liability exposures, is a complex process. For a high proportion of the risks insured or reinsured by ProAssurance, claims may be resolved over an extended period of time, often five years or more, and may be subject to litigation. Estimating losses requires ProAssurance to make and revise judgments and assessments regarding multiple uncertainties over an extended period of time. As a result, the reserve estimate may vary considerably from the eventual outcome. The assumptions used in establishing ProAssurance’s reserve are regularly reviewed and updated by management as new data becomes available. Changes to estimates of previously established reserves are included in earnings in the period in which the estimate is changed. ProAssurance believes that the methods it uses to establish reserves are reasonable and appropriate. Each year, ProAssurance uses internal actuaries to review the reserve for losses of each insurance subsidiary. ProAssurance also engages consulting actuaries to review ProAssurance claims data and provide observations regarding cost trends, rate adequacy and ultimate loss costs. The statutory filings of each insurance company with the insurance regulators must be accompanied by a consulting actuary's certification as to their respective reserves. ProAssurance considers the views of the actuaries as well as other factors, such as premium rates, historical paid and incurred loss development trends and an evaluation of the current loss environment including frequency, severity, expected effect of inflation, general economic and social trends, and the legal and political environment in establishing the amount of its reserve for losses. The effect of COVID-19 on recent historical trends regarding timing and severity of claims may also impact certain of these factors and the Company's ultimate estimation of losses (see "Item 1A, Risk Factors" included in this report for additional information). As a result of COVID-19, the industry has experienced new conditions, including the postponement of court cases and changes in settlement trends. ProAssurance's booked reserves as of December 31, 2022 include consideration of these factors, but the duration and degree to which these issues persist, along with potential legislative, regulatory or judicial actions, could result in significant changes to the Company's reserve estimates in future periods. ProAssurance partitions its reserve by accident year, which is the year in which the claim becomes its liability. For claims-made policies, the insured event generally becomes a liability when the event is first reported to the Company. For occurrence policies, the insured event becomes a liability when the event takes place. For retroactive coverages, the insured event becomes a liability at inception of the underlying contract. As claims are incurred (reported) and claim payments are made, they are aggregated by accident year for analysis purposes. ProAssurance also partitions its reserve by reserve type: case reserves and IBNR reserves. Case reserves are established by the claims department based upon the particular circumstances of each reported claim and represent ProAssurance’s estimate of the future loss costs (often referred to as expected losses) that will be paid on reported claims. Case reserves are decremented as claim payments are made and are periodically adjusted upward or downward as estimates regarding the amount of future losses are revised; a reported loss for an individual claim equates to the case reserve at any point in time plus the claim payments that have been made to date. IBNR reserves represent an estimate, in the aggregate, of future development on losses that have been reported to ProAssurance plus an estimate of losses that have been incurred but not reported. Acquired Reserve The acquisition of NORCAL increased ProAssurance's net reserves by $1.1 billion which represented the fair value of NORCAL's reserve, net of the fair value of related reinsurance recoverables, at the time of acquisition including a fair value adjustment on the reserve as well as negative VOBA recorded on NORCAL's unearned premium and DDR reserve. The reserve fair value adjustment will be amortized utilizing loss payment patterns and the negative VOBAs will be amortized over a period in proportion to the earn-out of the premium or in-line with the approximate consumption of losses. Such amortization is recorded as a reduction to net losses and loss adjustment expenses. Development of Prior Accident Years In addition to setting the initial reserve for the current accident year, each period ProAssurance reassesses the amount of reserve required for prior accident years. The foundation of ProAssurance’s reserve re-estimation process is an actuarial analysis that is performed by both the internal and consulting actuaries. This detailed analysis projects ultimate losses based on partitions which include line of business, geography, coverage layer and accident year. The procedure uses the most representative data for each partition, capturing its unique patterns of development and trends. ProAssurance believes that the use of consulting actuaries provides an independent view of the loss data as well as a broader perspective on industry loss trends. Reserving Methodologies For the HCPL, Medical Technology Liability and Workers’ Compensation lines of business, the analysis performed by the consulting actuaries analyzes each partition of the business in a variety of ways and uses multiple actuarial methodologies in performing these analyses, including: Bornhuetter-Ferguson (Paid and Reported) Method, Paid Development Method, Reported (Incurred) Development Method, Average Paid Value Method and Average Reported Value Method. Generally, methods such as the Bornhuetter-Ferguson Method are used on more recent accident years where there is less data available on which to base the analysis. As time progresses and an increased amount of data is available for a given accident year, management gives more confidence to the development and average methods, as these methods typically rely more heavily on ProAssurance's own historical data. These methods emphasize different aspects of loss reserve estimation and provide a variety of perspectives for ProAssurance's decisions. For the Workers’ Compensation line of business in both the Workers' Compensation Insurance and Segregated Portfolio Cell Reinsurance segments, ProAssurance utilizes the Reported (Incurred) Development Method, Paid Loss Development Method and Bornhuetter-Ferguson Method, to develop the reserve for each accident year. The actuarial review includes the stratification of claims data (lost time claims and medical only claims) using different variations that allow for identification of trends that may not be readily identifiable if the data was evaluated only in the aggregate. Reported and paid loss development factors are key assumptions in the reserve estimation process and are based on ProAssurance’s historical reported and paid loss development patterns. As accident years mature, the various actuarial methodologies produce more consistent loss estimates. For the Lloyd’s Syndicates segment business, losses are initially estimated using the loss assumptions by risk category incorporated into the business plan submitted to Lloyd’s with consideration given to loss experience incurred to date. These assumptions were influenced by loss results reflected in Lloyd’s historical data for similar risks. As losses are reported and resolved and loss experience becomes more credible from a statistical perspective, actual loss experience is incorporated into the estimates. Certain of the methodologies utilized to estimate the ultimate losses for each partition of the reserve consider the actual amounts paid. Paid data is particularly influential when a large portion of known claims have been closed, as is the case for older accident years. In selecting a point estimate for each partition, management considers the extent to which trends are emerging consistently for all partitions and known industry trends. Thus, actual, rather than estimated severity trends are given more consideration. If actual severity trends are lower than those estimated at the time that reserves were previously established, the recognition of favorable development is indicated. This is particularly true for older accident years where actuarial methodologies give more weight to actual loss costs (severity). The various actuarial methods discussed above are applied in a consistent manner from period to period. In addition, ProAssurance performs statistical reviews of claims data such as claim counts, average settlement costs and severity trends when establishing the reserve. Selected point estimates of ultimate losses are utilized to develop estimates of ultimate losses recoverable from reinsurers, based on the terms and conditions of ProAssurance’s reinsurance agreements. An overall estimate of the amount receivable from reinsurers is determined by combining the individual estimates. ProAssurance’s net reserve estimate is the gross reserve point estimate less the estimated reinsurance recovery. Activity in the reserve for losses and loss adjustment expenses is summarized as follows: (In thousands) 2022 2021 2020 Balance, beginning of year $ 3,579,940 $ 2,417,179 $ 2,346,526 Less reinsurance recoverables on unpaid losses and loss adjustment expenses 451,741 385,087 390,708 Net balance, beginning of year 3,128,199 2,032,092 1,955,818 Net reserves acquired from acquisitions — 1,089,103 — Net losses: Current year (1)(3) 813,515 797,732 711,846 Favorable development of reserves established in prior years, net (2) (36,753) (45,483) (50,399) Total 776,762 752,249 661,447 Paid related to: Current year (4) (108,139) (109,925) (83,204) Prior years (4) (757,564) (635,320) (501,969) Total paid (865,703) (745,245) (585,173) Net balance, end of year 3,039,258 3,128,199 2,032,092 Plus reinsurance recoverables on unpaid losses and loss adjustment expenses 431,889 451,741 385,087 Balance, end of year $ 3,471,147 $ 3,579,940 $ 2,417,179 (1) Current year net losses for the years ended December 31, 2022 and 2021 included $4.9 million and $6.7 million, respectively, of purchase accounting amortization of the negative VOBA associated with NORCAL's assumed unearned premium, which was amortized over a period in proportion to the earn-out of the associated premium as a reduction to current accident year net losses (see Note 2). As of June 30, 2022, the negative VOBA was fully amortized. (2) Net favorable prior year reserve development recognized for the years ended December 31, 2022 and 2021 included $10.8 million and $7.9 million, respectively, of amortization of the purchase accounting fair value adjustment on NORCAL's assumed net reserve and amortization of the negative VOBA associated with NORCAL's DDR reserve which is recorded as a reduction to prior accident year net losses and loss adjustment expenses (see Note 2). Net favorable prior accident year reserve development recognized in 2022 included favorable development related to NORCAL's 2021 accident year. ProAssurance has not recognized any development related to NORCAL's accident years 2020 or prior since the date of acquisition on May 5, 2021. (3) During 2020, a large national healthcare account did not renew on terms offered by the Company and exercised its contractual option to purchase extended reporting endorsement or "tail" coverage. As a result, ProAssurance recognized total current year losses of $60.0 million (assumes a full limit loss) within the Specialty P&C segment for the year ended December 31, 2020. (4) Paid losses for the years ended December 31, 2022 and 2021 included prior year paid losses of $262.5 million and $136.0 million, respectively, and current year paid losses of $16.6 million and $22.3 million, respectively, related to reserves acquired from NORCAL since May 5, 2021. As discussed in Note 1, estimating liability reserves is complex and requires the use of many assumptions. As time passes and ultimate losses for prior years are either known or become subject to a more precise estimation, ProAssurance increases or decreases the reserve estimates established in prior periods. The consolidated net favorable loss development recognized for the year ended December 31, 2022 primarily reflected lower than anticipated loss emergence in the Specialty P&C segment related to the 2017, 2020 and 2021 accident years, primarily attributable to NORCAL's 2021 accident year, and, to a lesser extent, the Medical Technology Liability line of business. The net favorable development recognized in the Specialty P&C segment also included a $9.0 million reduction in the Company's prior accident year IBNR reserve for COVID-19 as early first notices of potential claims related to anticipated COVID losses have not turned into claims. Further, the net favorable development recognized in the Specialty P&C segment was partially offset by higher than anticipated loss severity trends in select jurisdictions in the HCPL line of business, which emerged primarily in the fourth quarter of 2022. The net favorable development also reflected overall favorable trends in claim closing patterns in the Workers' Compensation Insurance and Segregated Portfolio Cell Reinsurance segments. The net favorable loss development recognized in the Workers' Compensation Insurance segment is primarily related to the 2017 through 2020 accident years. The net favorable loss development recognized in the Segregated Portfolio Cell Reinsurance segment is primarily related to the 2016 through 2021 accident years. Consolidated net favorable loss development recognized in 2022 was partially offset by unfavorable reserve development recognized in the Lloyd's Syndicates segment driven by higher than expected loss development on certain large claims, primarily catastrophe related losses. The net favorable loss development recognized for the year ended December 31, 2021 primarily reflected a lower than anticipated loss emergence in the Specialty P&C segment, primarily related to the 2015 through 2020 accident years. Net favorable prior accident year reserve development recognized in the Specialty P&C segment also included a $1.0 million reduction in the Company's IBNR reserve for COVID-19 during the third quarter of 2021. The net favorable development also reflected overall favorable trends in claim closing patterns in the Workers' Compensation Insurance and Segregated Portfolio Cell Reinsurance segments. The net favorable loss development recognized in the Workers' Compensation Insurance segment is primarily related to the 2012 through 2017 accident years. The net favorable loss development recognized in the Segregated Portfolio Cell Reinsurance segment is primarily related to accident year 2015 and accident years 2018 through 2020. Consolidated net favorable loss development recognized in 2021 was partially offset by unfavorable reserve development recognized in the Lloyd's Syndicates segment driven by certain catastrophe related losses. The net favorable loss development recognized for the year ended December 31, 2020 primarily reflected a lower than anticipated claims severity trend (i.e., the average size of a claim) in the Specialty P&C segment, primarily related to the 2014 through 2017 accident years. The net favorable development also reflected overall favorable trends in claim closing patterns in the Segregated Portfolio Cell Reinsurance and Workers' Compensation Insurance segments. The net favorable loss development recognized in the Segregated Portfolio Cell Reinsurance segment primarily related to the 2014 through 2019 accident years and the net favorable loss development recognized in the Workers' Compensation Insurance segment primarily related to the 2014 through 2017 accident years. Claims Development ProAssurance establishes its reserve and manages claims activity by coverage, product or line of business and various categories of reserves have similar characteristics. Therefore, ProAssurance has aggregated these reserve categories into several reserve groups in the following disclosures and tables that provide a more meaningful view of the amount, timing and uncertainty of cash flows arising from the liability. At the same time, these reserve groups present a disaggregated view of the major elements of the overall loss reserve liability. The reserve groups include HCPL claims-made reserve, HCPL occurrence reserve, Medical Technology Liability claims-made reserve, Workers’ Compensation Insurance reserve and Segregated Portfolio Cell Reinsurance - workers' compensation reserve. All other loss reserve categories are deemed to be less homogeneous or relatively small on a standalone basis and are included in other short-duration lines in the claims development reconciliation. The composition of the reserve groups is based on similar characteristics with respect to the risks being insured and the reporting and payout pattern of the underlying claims. In most instances the groups follow the coverage categorizations used in statutory financial reporting for U.S.-domiciled property-casualty insurance companies. HCPL claims are disaggregated into those claims covered by claims-made policies and those claims covered by occurrence policies. For claims-made policies, the insured event generally becomes a liability when the event is first reported to the insurer. For occurrence policies, the insured event becomes a liability when the event takes place, even if unknown at that time. Claims-made coverage has a short reporting pattern, with virtually all claims known shortly after the end of the policy period. Occurrence coverage claims can have an extended reporting pattern, with the time from the loss event until the filing of the claim often measured in years, at which point the claims resolution process begins. Although the resolution process and time frame is similar once a claim is reported, combining claims from claims-made and occurrence coverage types would result in distortion due to the difference in reporting lag. Medical Technology Liability reserves are grouped separately due to the nature of the risk, including the potential for mass torts and multiple claims arising out of the same product or service. The small amount of Medical Technology Liability occurrence reserves are included in other short-duration lines. Workers' compensation reserves in the Workers' Compensation Insurance and the Segregated Portfolio Cell Reinsurance segments are each grouped separately due to the difference in the type of coverage provided and the differences in the claims resolution process as compared to other liability insurance. The small amount of HCPL reserves in the Segregated Portfolio Cell Reinsurance segment are included in other short-duration lines. ProAssurance has elected to present reserve history for acquired entities in all periods shown in the tables below, including periods prior to acquisition. With the exception of the Workers' Compensation Insurance and Segregated Portfolio Cell Reinsurance - workers' compensation lines of business, virtually all other acquired entities are captured within the HCPL line of business. All information prior to 2022 disclosed in the Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance, Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance and Average Annual Percentage Payout of Incurred Claims by Age, Net of Reinsurance tables that follow is presented as supplementary information. The “Cumulative Number of Reported Claims” in the tables that follow includes the combined number of claims for an accident year and excludes projected unreported IBNR claims. A claim is considered reported when ProAssurance becomes aware of and accepts it for coverage under the terms of the Company's insurance contracts. Healthcare Professional Liability Reserve HCPL loss costs are impacted by many factors, including but not limited to the nature of the claim, including whether or not the claim is an individual or a mass tort claim, the personal situation of the claimant or the claimant's family, the outcome of jury trials, the legislative and judicial climate where any potential litigation may occur, general economic and social conditions and, for claims involving bodily injury, the trend of healthcare costs. ProAssurance sets an initial reserve based upon the evaluation of the current loss environment including frequency, severity, the expected effect of inflation, general economic and social trends, and the legal and political environment. The initial loss ratio for HCPL business has ranged from 83% to 106% in the past five years. ProAssurance has elected to present reserve history for NORCAL in all periods shown in the Healthcare Professional Liability tables below, including periods prior to acquisition. Healthcare Professional Liability Claims-Made Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance December 31, 2022 ($ in thousands) Year Ended December 31, 2022 IBNR* Cumulative Number of Reported Claims 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Accident Year Unaudited 2013 $ 527,520 $ 513,937 $ 501,580 $ 489,378 $ 480,036 $ 466,798 $ 451,182 $ 455,346 $ 457,038 $ 455,583 $ (29) 7,699 2014 — $ 509,774 $ 494,024 $ 491,403 $ 488,185 $ 474,317 $ 468,153 $ 470,189 $ 466,554 464,976 $ 566 7,523 2015 — — $ 503,412 $ 486,760 $ 492,824 $ 491,180 $ 500,336 $ 500,550 $ 503,600 503,628 $ (4,337) 7,409 2016 — — — $ 484,153 $ 488,349 $ 507,586 $ 555,416 $ 554,395 $ 560,840 557,097 $ (542) 7,986 2017 — — — — $ 508,072 $ 506,207 $ 577,401 $ 569,737 $ 573,570 557,620 $ (14,294) 8,067 2018 — — — — — $ 544,617 $ 643,864 $ 630,169 $ 636,023 642,948 $ (62,313) 8,478 2019 — — — — — — $ 670,958 $ 664,934 $ 642,370 646,676 $ (22,209) 8,452 2020 — — — — — — — $ 593,994 $ 574,274 557,651 $ (21,795) 6,689 2021 — — — — — — — — $ 527,718 524,468 $ 78,103 5,289 2022 — — — — — — — — — 464,069 $ 269,309 4,626 Total $ 5,374,716 * Includes expected development on reported claims Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance (In thousands) Year Ended December 31, 2022 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Accident Year Unaudited 2013 $ 30,214 $ 142,759 $ 255,605 $ 328,982 $ 376,930 $ 398,549 $ 415,012 $ 430,916 $ 435,158 $ 439,029 2014 — $ 30,483 $ 125,078 $ 246,510 $ 325,782 $ 389,983 $ 416,150 $ 434,540 $ 439,575 446,402 2015 — — $ 26,664 $ 125,234 $ 256,791 $ 351,703 $ 410,506 $ 446,069 $ 463,224 476,664 2016 — — — $ 27,442 $ 137,338 $ 276,548 $ 378,828 $ 440,163 $ 472,441 499,431 2017 — — — — $ 32,342 $ 147,515 $ 288,695 $ 351,548 $ 419,180 467,423 2018 — — — — — $ 34,238 $ 159,657 $ 279,204 $ 367,522 450,952 2019 — — — — — — $ 37,755 $ 144,225 $ 259,889 364,411 2020 — — — — — — — $ 32,270 $ 117,153 234,804 2021 — — — — — — — — $ 23,494 110,483 2022 — — — — — — — — — 24,792 Total 3,514,391 All outstanding liabilities before 2013, net of reinsurance 19,514 Liabilities for losses and loss adjustment expenses, net of reinsurance $ 1,879,839 Healthcare Professional Liability Occurrence Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance December 31, 2022 ($ in thousands) Year Ended December 31, 2022 IBNR* Cumulative Number of Reported Claims 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Accident Year Unaudited 2013 $ 51,996 $ 54,143 $ 49,970 $ 53,905 $ 56,640 $ 50,632 $ 49,270 $ 47,550 $ 48,116 $ 47,144 $ 998 640 2014 — $ 45,975 $ 43,606 $ 44,075 $ 40,699 $ 37,653 $ 34,428 $ 33,353 $ 35,139 35,839 $ 1,179 543 2015 — — $ 52,531 $ 54,890 $ 56,621 $ 57,606 $ 52,455 $ 51,276 $ 56,468 61,198 $ 391 615 2016 — — — $ 56,089 $ 49,795 $ 53,358 $ 56,345 $ 66,886 $ 64,122 68,674 $ 2,300 710 2017 — — — — $ 45,463 $ 42,338 $ 40,983 $ 44,449 $ 46,865 50,652 $ 4,283 743 2018 — — — — — $ 59,351 $ 61,880 $ 63,576 $ 73,599 74,419 $ 1,388 709 2019 — — — — — — $ 63,548 $ 58,555 $ 70,926 86,543 $ 6,155 827 2020 — — — — — — — $ 165,955 $ 178,804 181,643 $ 79,785 1,641 2021 — — — — — — — — $ 82,590 81,254 $ 47,133 422 2022 — — — — — — — — — 82,436 $ 78,046 135 Total $ 769,802 * Includes expected development on reported claims Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance (In thousands) Year Ended December 31, 2022 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Accident Year Unaudited 2013 $ 539 $ 4,620 $ 12,130 $ 25,131 $ 30,474 $ 37,778 $ 40,775 $ 42,455 $ 43,254 $ 44,419 2014 — $ 512 $ 4,674 $ 11,192 $ 17,349 $ 22,649 $ 25,671 $ 27,753 $ 30,407 31,285 2015 — — $ (180) $ 2,617 $ 9,953 $ 20,627 $ 28,482 $ 36,413 $ 41,800 52,017 2016 — — — $ 44 $ 2,750 $ 15,433 $ 28,362 $ 40,766 $ 48,691 54,324 2017 — — — — $ (6,631) $ (3,385) $ 3,592 $ 11,051 $ 19,696 30,489 2018 — — — — — $ 444 $ 6,193 $ 15,229 $ 26,932 37,828 2019 — — — — — — $ 628 $ 4,575 $ 10,399 26,359 2020 — — — — — — — $ 397 $ 6,194 21,100 2021 — — — — — — — — $ 762 4,335 2022 — — — — — — — — — 675 Total 302,831 All outstanding liabilities before 2013, net of reinsurance 5,095 Liabilities for losses and loss adjustment expenses, net of reinsurance $ 472,066 Average Annual Percentage Payout of Incurred Claims by Age, Net of Reinsurance Years 1 2 3 4 5 6 7 8 9 10 Unaudited Healthcare Professional Liability Claims-Made 5.6% 19.2% 23.1% 15.9% 12.0% 6.4% 4.0% 2.4% 1.2% 0.8% Healthcare Professional Liability Occurrence (0.7%) 6.1% 13.2% 18.6% 14.8% 13.9% 7.3% 9.2% 2.1% 2.5% Medical Technology Liability Reserve The risks insured in the Medical Technology Liability line of business are more varied, and policies are individually priced based on the risk characteristics of the policy and the account. These policies often have substantial deductibles or self-insured retentions, and the insured risks range from startup operations to large multinational entities. Premiums are established using the most recently developed actuarial estimates of losses expected to be incurred based on factors which include: results from prior analysis of similar business, industry indications, observed trends and judgment. Claims in this line of business primarily involve bodily injury to individuals and are affected by factors similar to those of the HCPL line of business. For the Medical Technology Liability line of business, ProAssurance also establishes an initial reserve using a loss ratio approach, including a provision in consideration of historical loss volatility that this line of business has exhibited. Medical Technology Liability Claims-Made Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance December 31, 2022 ($ in thousands) Year Ended December 31, 2022 IBNR* Cumulative Number of Reported Claims 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Accident Year Unaudited 2013 $ 9,807 $ 9,955 $ 9,536 $ 7,226 $ 4,697 $ 3,566 $ 3,504 $ 3,305 $ 3,199 $ 3,164 $ 60 218 2014 — $ 9,989 $ 10,306 $ 9,012 $ 8,984 $ 7,679 $ 6,194 $ 5,888 $ 5,636 5,472 $ 242 272 2015 — — $ 9,376 $ 8,757 $ 7,193 $ 5,929 $ 5,081 $ 4,664 $ 4,192 3,499 $ 75 156 2016 — — — $ 9,200 $ 8,467 $ 7,413 $ 6,422 $ 6,241 $ 4,491 5,145 $ 689 182 2017 — — — — $ 11,049 $ 10,143 $ 8,306 $ 4,919 $ 3,381 5,351 $ 1,278 98 2018 — — — — — $ 10,141 $ 8,108 $ 7,506 $ 4,961 4,646 $ 794 218 2019 — — — — — — $ 10,072 $ 8,324 $ 9,588 7,658 $ 1,272 361 2020 — — — — — — — $ 11,082 $ 10,671 9,150 $ 6,637 178 2021 — — — — — — — — $ 13,914 11,909 $ 9,562 174 2022 — — — — — — — — — 15,014 $ 14,733 159 Total $ 71,008 * Includes expected development on reported claims Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance (In thousands) Year Ended December 31, 2022 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Accident Year Unaudited 2013 $ 102 $ 1,029 $ 1,967 $ 2,599 $ 3,092 $ 3,102 $ 3,102 $ 3,102 $ 3,101 $ 3,102 2014 — $ 388 $ 1,527 $ 2,564 $ 3,046 $ 3,724 $ 3,776 $ 4,074 $ 4,076 4,076 2015 — — $ 25 $ 440 $ 1,625 $ 2,097 $ 2,567 $ 2,911 $ 2,987 2,989 2016 — — — $ 53 $ 1,690 $ 2,365 $ 2,959 $ 4,295 $ 4,342 4,383 2017 — — — — $ 56 $ 1,681 $ 2,017 $ 2,360 $ 2,867 4,073 2018 — — — — — $ 6 $ 191 $ 1,850 $ 2,651 3,065 2019 — — — — — — $ 584 $ 2,552 $ 3,902 5,321 2020 — — — — — — — $ 40 $ 526 1,034 2021 — — — — — — — — $ 4 384 2022 — — — — — — — — — 24 Total 28,451 All outstanding liabilities before 2013, net of reinsurance 36 Liabilities for losses and loss adjustment expenses, net of reinsurance $ 42,593 Average Annual Percentage Payout of Incurred Claims by Age, Net of Reinsurance Years 1 2 3 4 5 6 7 8 9 10 Unaudited Medical Technology Liability 2.1 % 18.0 % 20.1 % 13.7 % 14.3 % 6.9 % 2.1 % — % — % — % Workers' Compensation Insurance Reserve Many factors affect the ultimate losses incurred for the workers' compensation coverages in the Workers' Compensation Insurance segment including, but not limited to, the type and severity of the injury, the age and occupation of the injured worker, the estimated length of disability, medical treatment and related costs, and the jurisdiction and workers' compensation laws of the injury occurrence. ProAssurance uses various actuarial methodologies in developing the workers’ compensation reserve combined with a review of the exposure base generally based upon payroll of the insured. For the current accident year, given the lack of seasoned information, the different actuarial methodologies produce results with considerable variability; therefore, more emphasis is placed on supplementing results from the actuarial methodologies with trends in exposure base, medical expense inflation, general inflation, severity, and claim counts, among other things, to select an expected loss ratio. Workers' Compensation Insurance Incurred Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance December 31, 2022 ($ in thousands) Year Ended December 31, 2022 IBNR* Cumulative Number of Reported Claims 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Accident Year Unaudited 2013 $ 86,973 $ 85,935 $ 86,928 $ 88,010 $ 87,260 $ 87,260 $ 89,760 $ 89,560 $ 88,930 $ 88,557 $ — 16,429 2014 — $ 93,019 $ 93,529 $ 93,029 $ 93,029 $ 93,029 $ 93,029 $ 91,329 $ 90,532 89,639 $ — 16,210 2015 — — $ 100,101 $ 100,454 $ 98,454 $ 97,654 $ 96,354 $ 93,054 $ 91,840 90,547 $ — 16,551 2016 — — — $ 101,348 $ 97,348 $ 92,148 $ 84,799 $ 82,799 $ 80,751 78,808 $ — 15,979 2017 — — — — $ 99,874 $ 99,874 $ 99,874 $ 97,874 $ 95,674 92,715 $ 311 16,085 2018 — — — — — $ 118,095 $ 118,095 $ 120,095 $ 120,095 120,056 $ 1,567 18,016 2019 — — — — — — $ 115,852 $ 115,852 $ 115,352 112,534 $ 1,481 17,527 2020 — — — — — — — $ 102,475 $ 102,475 101,621 $ 2,785 14,526 2021 — — — — — — — — $ 105,722 108,722 $ 4,913 15,479 2022 — — — — — — — — — 104,675 $ 29,086 14,763 Total $ 987,874 * Includes expected development on reported claims Cumulative Paid Claims and Allocated Claim Adjustment Expenses, Net of Reinsurance (In thousands) Year Ended December 31, 2022 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Accident Year Unaudited 2013 $ 30,554 $ 63,825 $ 76,813 $ 82,369 $ 85,689 $ 86,783 $ 87,466 $ 87,772 $ 88,033 $ 88,074 2014 — $ 30,368 $ 65,922 $ 77,631 $ 85,022 $ 87,314 $ 87,998 $ 88,487 $ 88,977 89,081 2015 — — $ 32,078 $ 65,070 $ 78,947 $ 83,483 $ 86,528 $ 87,884 $ 88,476 89,089 2016 — — — $ 28,377 $ 58,192 $ 69,237 $ 74,886 $ 76,954 $ 77,546 77,265 2017 — — — — $ 31,586 $ 70,333 $ 82,289 $ 87,129 $ 88,504 88,953 2018 — — — — — $ 41,619 $ 86,063 $ 104,216 $ 110,928 114,525 2019 — — — — — — $ 40,994 $ 84,108 $ 100,373 105,724 2020 — — — — — — — $ 32,447 $ 74,532 90,174 2021 — — — — — — — — $ 39,634 81,499 2022 — — — — — — — — — 38,734 Total 863,118 All outstanding liabilities before 2013, net of reinsurance 12,558 Liabilities for losses and loss adjustment expenses, net of reinsurance $ 137,314 Average Annual Percentage Payout of Incurred Claims by Age, Net of Reinsurance Years 1 2 3 4 5 6 7 8 9 10 Unaudited Workers' Compensation Insurance 35.0 % 38.7 % 14.4 % 6.0 % 2.8 % 0.9 % 0.4 % 0.5 % 0.2 % — % Segregated Portfolio Cell Reinsurance - Workers' Compensation Reserve The Company estimates and reserves for the workers' compensation business assumed by the Segregated Portfolio Cell Reinsu |
