ACORD 130 Workers Compensation Tutorials Table of Contents

Table of Contents for all Tutorials on How to Complete the ACORD 130 Workers Compensation Application

ACORD 130 Agency Information

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation.html

ACORD 130 Agent Information

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation-app.html

ACORD 130 Carrier and Applicant Information

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation_24.html

ACORD 130 Status of Submission, Billing and Audit Section

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation_25.html

ACORD 130 Locations Section

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation_28.html

ACORD 130 Policy Information Section

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation-section.html

ACORD 130 Total Estimated Premium Section

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation_30.html

ACORD 130 Contact Information Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation.html

ACORD 130 Individuals Included / Excluded Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation.html

ACORD 130 Rating Information Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_5.html

ACORD 130 Premium Calculation Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_6.html

ACORD 130 Remarks Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_7.html

ACORD 130 Prior Carrier and Loss History Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_8.html

ACORD 130 Nature of Business / Description of Operations Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_9.html

ACORD 130 General Information Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_12.html

ACORD 130 Signatures and Notice of Information Practices

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_13.html

ACORD 130 Workers Compensation Application Signature Section

How to Complete the Signature Section of the Workers Compensation Application

At the top hand corner of the signature section of the ACORD 130 workers compensation application is a check box you need to check to state that you have given this insured a copy of the Notice of Information Practices form.

This is the ACORD 38 form for most states. The following states have their own form as of this writing...

ACORD 38AR - Arkansas

ACORD 38AZ - Arizona

ACORD 38CA - California

ACORD 38CT - Connecticut

ACORD 38DE - Delaware

ACORD 38GA - Georgia

ACORD 38IL - Illinois

ACORD 38MT - Montana

ACORD 38NH - New Hampshire

ACORD 38NJ - New Jersey

ACORD 38NV - Nevada

ACORD 38OR - Oregon

ACORD 38RI - Rhode Island

ACORD 38VA - Virginia

ACORD 38WA - Washington

Not all states require a notice. Check with an experienced agent at your agency or with your underwriter.

In the bottom left hand corner of the first section of the Signature section there is a place to get your insured to initial. Don't forget this.

At the very bottom of the 4th page is a place for the Applicant's Signature and next to it a space to have the insured date their signature.

Next to that is a spot for your - the agent's - signature.

Finally there is a box for your National Producer Number if your agency has one.

If you are using our Cap Dat ACORD services we have an electronic, or e-signature, feature available to you. You can add this to the signature box and email a link to the form to your insured. They can then review and sign the form on a tablet, smart phone or most current browsers. This gives you an extra level of legal documentation on the time and date of the signature. It can also save time.

I hope this group of posts have been helpful in your learning more about how to complete the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application General Information

How to Complete the General Information Section of ACORD 130 Workers Compensation App

This general information section continues on page 4 of the ACORD 130. This post will cover these questions on both pages.

As noted in the form, you will put a Y for yes or an N for no in the box in the far right hand column which matches the row which contains the question you are answering. Plain English, for the first question put a Y or N in the box at the end of the question on the right.

If you answer Yes to any of these questions you need to explain your answer in more detail. You will use the Remarks section on page 2 of this application, or the ACORD 130 form if you need more space to answer.

These questions have changed over time and will continue to change. So I will not go through each question individually.

I will point out that many of these questions should cause you to think about the coverage you are applying for. Example, if you say yes to any work preformed on barges, vessels, docks, bridge over water, should you be providing Longshoreman's  coverage?

If you are in Missouri, be certain you do not answer the question about prior coverage being declined.

I personally question the legality of the question about employees with physical handicaps.

Keep in mind these are underwriting questions which do not have an effect on the rate, but may have a significant effect on the discounts the underwriter is willing to apply.

I trust this has helped you learn how to complete the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application Nature of Business Seection

How to Complete the Nature of Business /Description of Operations Section of the ACORD 130

This is a large, free form entry section.

You need to be as inclusive as possible about what your customer does. This is where you can really sell your underwriter on this customer. It will also have an impact in how your underwriter decides to classify the payroll class codes.

Pay attention to the list in the top box above the free forms box and give descriptions and comments on:

Manufacturing:
Raw Materials
Processes
Product
Equipment

Contractor:
Type of Work
Sub-Contracts

Mercantile:
Merchandise
Customers
Deliveries

Service:
Type
Location

Farm:
Acreage
Animals
Machinery
Sub-Contract

I hope this helps you learn how to complete the nature of business and description of operations section of the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application Prior Carrier / Loss History

How to complete the ACORD 130 Prior Carrier Information and Loss History Section

LOSS RUN ATTACHED:  Notice in the top left hand corner of the very first row of this section is a small check box for Loss Run Attached. If you are including a separate document with prior carrier's loss run, check this box.

YEAR: Enter a 4 digit year for each row in this section. Your carrier will want five years history if the business has been in business for that long. This will give them enough information to determine if experience rating plans can apply.

CARRIER & POLICY NUMBER: For each of the five years of prior information, enter the insurance carrier name in the box labeled "CO:". Enter the Policy number in the box labeled "POL#". Include any prefixes and suffixes in the policy number. Example WC 989384-04.

ANNUAL PREMIUM: This should be the final audited premium, not the original estimated premium. Enter numerically as a dollar amount.

MOD: This is the Experience or Merit Modification. This will show on the declarations page of each previous policy.

#CLAIMS: Enter a numeric value for the total number of claims filed for this policy period.

AMOUNT PAID: Enter the total amount paid to date for the claims you listed in the #Claims box. Note, this is not the same as claims paid in this year. Some claims will occur in one policy year and have payments made for many years into the future. This space should show the payments related to claims filed in this year to the best of your ability.

RESERVE: This is the amount the carrier has set aside for future payments on claims already filed.

For instance, if a worker suffers a permanent disability from their work, the claim may include lifetime payments. The reserve amount will be the estimated amount to be paid during the lifetime of that worker.

As another example, the worker may not have a permanent disability, but medical treatment may not yet be complete. The reserve will be the estimate for the remaining treatment cost.

Do not confuse reserves with a maximum amount to be paid. Reserves may be increased or decreased as facts change. Reserves are an educated estimate.

I hope this is helpful in your process of learning how to complete the prior carrier information and loss history on the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application Remarks Section

How to Complete the Remarks Section of the Workers Compensation Application

The Remarks Section is a free form place to enter all the additional information you did not have room to enter anywhere else in this application.

Several items on the first page specifically mention using the Remarks Section.

Under Policy Information it tells you to specify additional coverage or endorsements in Remarks.

While Locations does not mention it, if you have more than 3 locations, this is the place to list those additional locations.

The Individuals Included / Excluded mentions using the Remarks section if you have more than 4 people to list.

I have also seen it used for things that are not asked at all. Such as the fact that the insured is the brother-in-law of the agent. Who knew?

You may need even more room than the Remarks section provides. When that is the case, use the ACORD 101 Additional Remarks Schedule.

I hope this helps you learn how to complete the ACORD 130 workers compensation application remarks section.

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ACORD 130 Workers Compensation Applications - Premium Section

How to Complete the Premium Section of the ACORD 130 Workers Compensation Application

Before you get too worked up about this section, I advise this section is for the underwriter to complete. They are giving you the quote. Let them do their job.

If you are generating this form from a rating software product, all this information will be in the rating software. At worst you will be cutting and pasting.

It is to your benefit to understand how the premiums are created. The more you understand the details of how to create the premiums, the more you can keep your customer's premiums at the correct level. Fewer surprises at audit are always a good thing.

STATE: The state abbreviation for the locations this worksheet is covering.

COLUMNS in the WORKSHEET

FACTOR: There may be factors - numeric values which you will use to modify the premium up or down.

FACTORED PREMIUM: This will be the mathematical result of multiplying the Estimated Total Premium from the worksheet above this section by the Factor in the same row of the column labeled FACTOR.

EXAMPLE:

The first Row is TOTAL: This is the sum total of all the estimated annual manual premiums from the worksheet on this page.

The second row is increased limits. If you recall under the Policy Information Section on page one of the ACORD 130 form, Part 2 - Employer's Liability allowed you to have higher than basic limits of coverage. If you chose higher limits, there will an increase limits factor.

Let's say we have a Total Premium of $2,000. and an increased limits factor of 1.1.

You enter the $2,000 in the first row / third column.

You enter the increased limits factor of 1.10 in the second row, second column.

You multiply the premium in the first row by the factor in the second row to get the Factored Premium you put in the third column of the second row.

$2,000 times 1.1 = $2,200.

You repeat this process adjusted for the previous numbers throughout this section.

Now on to the terms used in this section.

INCREASED LIMITS: As described above, this is a factor that applies if you increase limits for Part 2 - Employer's Liability. This will increase the premium.

DEDUCTIBLE: If a state deductible is available and you chose to use it, enter the deductible factor here. This will reduce the premium.

EXPERIENCE OR MERIT MODIFICATION: If this business has had workers comp insurance for at least two years under the same ownership, and the business has had a workers comp premium both years that meets the state minimum for creating an experience or merit modification, you will enter that modification here. These modifications are based on losses versus premiums. It can result in either an increase or a decrease of the premium. It depends on loss history.

ASSIGNED RISK SURCHARGE: If this risk is being placed in a state Assigned Risk program, there will usually be a surcharge that applies. It will always increase the premium.

ARAP: This is the Assigned Risk Adjustment Program. If your state has this, enter that factor here.

SCHEDULE RATING: Scheduled rating is generally a factor that an individual carrier will develop on its own to more properly price a risk. Normally these are credits and reduce the premium.

CCPAP: Contracting Class Premium Adjustment Program. This provides a credit for construction industry employers who pay high hourly wages. It applies only to the construction class codes and not to the premium developed by other class codes on the same policy. For instance, it would not be applied to office workers.

You would normally expect these to apply only in major metropolitan ares, but I would ask about this if I were insuring a business in an area that was recovering from a significant natural disaster. Think New Orleans after Katrina or Staten Island after Sandy.

STANDARD PREMIUM: The unmodified premium. The premium from the Estimated Annual Manual Premium from the worksheet above.

PREMIUM DISCOUNT:  Large premium levels may create a premium discount. Sort of like a volume discount at a retail store.

EXPENSE CONSTANT: Generally there is a standard Expense Constant for most class codes in each state's workers compensation manual. Some class codes have a higher Expense Constant. These will be shown next to the rates when you look up the class codes and the rates. While each state will have rules about how you apply the Expense Constant if there is more than one, I believe I recall you only apply the one highest Expense Constant instead of adding them all together.

This is not a factor but a hard dollar amount. It will increase the premium. All workers comp policy have an Expense Constant.

TAXES AND ASSESSMENTS:  If you are writing this risk with a non-admitted carrier, you will need to add the premium taxes and other appropriate fees here.

TOTAL ESTIMATED ANNUAL PREMIUM:  This is the total after applying all the adjustments in this section to the estimated annual premium.

MINIMUM PREMIUM: Each class code will show a minimum premium next to the rates. If the Total Estimated Annual Premium is not higher than the Minimum Premium, you will charge the minimum premium.

If there is more than one class code, usually only the highest minimum premium applies.

DEPOSIT PREMIUM: The amount the insured must pay on or before the policy goes into effect.


Well, that is a lot. I hope it helps you understand workers compensation rating a little better.

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ACORD 130 Workers Compensation Application - Rating Information Section

How to Complete the Rating Information Section for the ACORD 130

The state rating worksheet rating information section of the worker compensation application is the heart and soul of the application.

STATE: Before you get into the main part of the section, enter the state for which this rating information applies.

LOC#: Location should track the location number listed in the LOCATIONS section on page 1.

CLASS CODE: This is a 4 digit code that corresponds to the type of work being done by the people whose payroll you are using to create the premiums.

The most common question we get is "Where do I find the Workers' Compensation Class Code?"

Here are some links to these codes...

https://www.wcrb.org/wcrb/classcode/main.asp

http://www.wcirb.com/content/classification-information

http://www.workerscompensationshop.com/workers_compensation_class_codes.htm

http://www.tdi.texas.gov/wc/regulation/

This used to be the hardest question to answer. I love Google. Just enter the phrase "workers compensation code" and then the name of the state you need the codes for, and you will get that information toute suite.

CATEGORIES, DUTIES, CLASSIFICATIONS: In the process of finding the class code, you will also have found the text to enter here.

Example: Code 8810 - Clerical Office Employees NOC. The NOC stand for not otherwise classified. They might work in an office but be some other classification such as Inside Sales, etc.

# EMPLOYEES: Enter a numeric value for the number of Full Time and the number of Part Time Employees classified under this code for this state.

SIC: Standard Industry Classification Code. You can find these at this link...

https://www.osha.gov/pls/imis/sicsearch.html

NAICS: The good old North American Industry Classification System codes. My Mother used to read these to me at bedtime. You can find them at these links...

https://www.census.gov/eos/www/naics/

https://www.census.gov/eos/www/naics/

ESTIMATED ANNUAL REMUNERATION / PAYROLL: Why ask for anything other than payroll? Sometimes room and board is considered remuneration and the carrier can include that when they audit the risk at the end of the policy term.

This is the total payroll for this classification adjusted for maximum payrolls for Executive Officers, Partners and Owners, for this classification for this state.

RATE: When you look up the Class code on a state specific or company specific site, you should see the rate for that class code listed. The rate is a dollar amount such as $0.52 or $3.14.

ESTIMATED ANNUAL MANUAL PREMIUM: The rate applies per $100.00 of payroll. So multiple the rate times the Payroll and divide by 100 to get this number..

Example:

Your Annual Payroll is $100,000.

Your Rate for this Class Code is $0.52

Multiple 100,000 times .52 = $52,000.

Divide $52,000 by 100 = $520.


I hope this helps you learn how to complete the State Rating Worksheet for the ACORD 130 Workers Compensation application.

We all learn for the first time some time.

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ACORD 130 Workers Compensation Application - Individuals Included / Excluded Section

How to Complete the Workers Compensation Individuals Included / Excluded Section

The last section on page 1 of the ACORD 130.

INDIVIDUALS INCLUDE / EXCLUDED

Some States allow Partners and/or Officers of a business to be excluded from workers compensation coverage. This saves the company money on the cost of the workers compensation policy in some cases.

In some other States you need to specifically include Partners and Officers. Note - they must actually be employed by the business to be included.

Check with an experienced agent in your office or your carrier underwriter to find out the details for a specific state.

For each individual you wish to include or exclude, you need to list the following information in this section of the application. If you need more space for more than four individuals use the Remarks Section at the bottom of page 2, or attached the ACORD 101 form.

STATE: The state in which this person would be employed.

LOC#: This would track the location number listed in the LOCATIONS section higher up on this first page of the ACORD 130.

NAME: The person's full name.

DATE OF BIRTH: The person's full date of birth.

TITLE / RELATIONSHIP: The title the person has at the business or relationship. Example, President, or Owner.

OWNER-SHIP %: The percentage of ownership this person has. Your customer will be able to provide this information.

DUTIES: The actual job this person does for this company. (I can't help it. I watched too many episodes of the Simpsons with my son. I laugh every time I hear the word duty. I flash to Bart saying "He said duty")

INC/EXC: Include or exclude from coverage. Enter the letters INC to include coverage for this person. Enter the letters EXC to exclude coverage for this person.

CLASS CODE: This is the workers compensation class code this person's job would fall under. I will discuss class codes in the very next post.

REMUNERATION/PAYROLL: Each state has a maximum payroll limitation for Officers, Directors and Owners. So this may not be this person's actual payroll. You need to check with an experienced agent in your office or your carrier underwriter to learn the limitations for your states.

When I was a young workers comp underwriter, back when Jesus was in grade school, the limit was $15,600. You would not want the premium to be computed on the $1,000,000 annual salary we all know our bosses secretly make. That would run the premium up way too high. We would then not be competitive with other agents quoting this account and therefor not get this business. A bad thing.


I hope this helps you learn how to complete the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application - Contact Information Section

How to Complete the ACORD 130 Contact Information Section

This section is the next to the last one on page one of the ACORD 130.

Contact Information

This is information on the people to contact at your customer's office for the following:

INSPECTION: This would be for the carrier to schedule a physical safety inspection of the insured's premises or operations away from the premises. One of the valuable services many insurance providers of workers compensation offer is safety inspections to give your insured's ideas on how to change their processes to reduce the risk of worker's injuries. A win for everyone.

ACCTING: Accounting.  This would be your customer's bookkeeper, accountant, or whoever would be able to provide the actual payroll information. In a smaller business this might be the owner.

Remember, the workers compensation policy can be adjusted after the policy period to change the premium to reflect the actual payroll during the policy period. This can result in a refund, if the actual payroll was less than the estimate, or an additional charge if the actual payroll was more than the estimate.

If you are aware that your customer is either growing dramatically or shrinking dramatically, you will be doing them a favor to suggest updating the estimate during the policy period.

CLAIMS INFO: Claims information. This would be the person at your customer's business that would keep the record of all First Reports of Claims. The carrier's claims adjuster would co-ordinate with this person.

For each of the above contacts provide the following:

NAME:

OFFICE PHONE: Include personal extension if there is one.

MOBILE PHONE: If the person has a business mobile phone, this would be that number. Only provide the person's personal mobile phone number if you get their permission in writing to do so. This is both a courtesy and a legal protection for you and your agency.

E-Mail: The person's business email, not personal email. Again, only provide personal email with written permission to do so.

I hope this helps you learn how to complete the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application - Total Estimated Annual Premium

How to Complete the ACORD 130 Workers Compensation Application

The Total Estimated Annual Premium - All States section is the 5th section down on the ACORD 130.

The numbers you enter here come from the Premium Section on page 2. If you are using Cap Dat ACORD forms these fields will automatically fill once you have completed the Premium Section on Page 2.

TOTAL ESTIMATED ANNUAL PREMIUM: The important word here is "estimated". Workers compensation premiums are subject to audit and adjustment based on the actual payroll during the policy premium.

TOTAL MINIMUM PREMIUM: Each workers compensation class code has its own minimum premium that will be charged regardless of the actual result of the rate times the payroll. You enter the highest minimum premium for any individual class code on this policy in this space.

TOTAL DEPOSIT PREMIUM ALL STATES: This is the amount you need to collect from your customer to send in with the application. Check with your company on payment plans. Each company's payment plans will have their own minimum deposit amount.

If your carrier does not have a payment plan option, consider offering a premium finance option to your customer. In many states your agency may be able to receive some additional revenue from a premium  finance company for placing customers with that specific premium finance company. Something to think about.

I hope this helps you learn how to complete the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Section - Policy Information

How to Complete the Policy Information Section of the ACORD 130

Policy Information

PROPOSED EFF DATE: The proposed effective date for this policy. For data entry purposes most online forms will force you to use a database friendly format. Cap Dat ACORD forces DD/MM/YYYY. Example 01/01/2014.

PROPOSED EXP DATE:  The proposed expiration date for this policy. For data entry purposes most online forms will force you to use a database friendly format. Cap Dat ACORD forces DD/MM/YYYY. Example 01/01/2014.

NORMAL ANNIVERSARY RATING DATE: This will most likely be the same as the proposed effective date. The rating date is important for when any appropriate rating bureau would calculate an experience modification. Reasons the dates might not be the same could be purchase of insured by another company or mid term cancellation by a previous insurance carrier.

PARTICIPATING OR NON-PARTICIPATING:  (Quoted from the ACORD FIG) A Participating policy may result in reduced premiums through the payment of policyholder dividends declared by the insurer. Some policyholder dividends are based on actual experience of the applicant. If such a program is available through the company in the covered state, indicate whether the policy is to be on a Participating or Non-Participating basis. Check with your company on the availability of plans.

RETRO PLAN: This is a retrospective rating plan. It means that, subject to minimum and maximum premiums, the final actual premium will be computed after the policy period based on actual payroll and actual losses.

PART 1 - WORKERS COMPENSATION (STATES): Part 1 refers to the state by state workers compensation laws. List all states in which workers compensation is provided by this policy. Use the Remarks section at the bottom of page 2 if more space is needed.

PART 2 - EMPLOYER'S LIABILITY: Enter the limits for EACH ACCIDENT, DISEASE-POLICY LIMIT, DISEASE-EACH EMPLOYEE. Check with your underwriter to see what limits apply in each state.

PART 3 - OTHER STATES INS: Part 3 refers to states not listed in Part 1, but where your customer is likely to have operations at some point during this policy term.

DEDUCTIBLES (N/A IN WI): Check with your underwriter or an experienced agent in your office to see if deductibles apply in the states for which workers compensation coverage is being provided. These check boxes are not mutually exclusive. The third check box with no text is for any other deductible type.

AMOUNT / % (N/A WI): Enter the percentage amount or the hard dollar amount of the deductible. Example 1% or $1,000. Choose one format or the other. Check with your underwriter to see which applies, if any.

OTHER COVERAGES: Check all that apply.

U.S.L&H - United States Longshoremen's and Harbor Workers coverage

VOLUNTARY COMP: Voluntary Compensation

FORGEIN COV: Foreign coverage

MANAGED CARE OPTION

DIVIDEND PLAN/SAFETY GROUP: This is related to Participatory Plans. Check with your underwriter to get name of group.

ADDITIONAL COMPANY INFORMATION: This is a wide open area with anything else the company feels needs to be listed.

SPECIFY ADDITIONAL COVERAGES/ENDORSEMENT (ATTACH ACORD 101, ADDITIONAL REMARKS SCHEDULE, IF MORE SPACE IS NEEDED.): Anything you need on the policy, or endorsements you need to be issued with the policy should be listed here.

I hope this helps you better understand how to complete the ACORD 130 Workers Compensation Application.

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ACORD 130 Workers Compensation Application - Locations Section

How to Complete the Locations Section in the ACORD 130 Workers Compensation Application

The Locations section has room for only three locations. What if you have more? Use the Remarks section at the bottom of page 2. If that is still not enough use the ACORD 101 Additional Remarks Schedule.

LOC# - This means Location number in plain English. Use numbers 1, 2 and 3. Not Letters.

HIGHEST FLOOR - I have no idea why they ask this question. I suppose the risk of steps or jumping. Anyway, this is just the number of the highest floor at the location. Whether your customer is on that floor or not is not asked. I would add this to the Remarks Section at the bottom of page 2.

STREET, CITY, COUNTY, STATE, ZIP CODE - While ACORD has done an admirable job here of not using abbreviated words, They have made a mess of data entry. At a minimum just use a 2 character entry for STATE - NC instead of North Carolina.

I hope this helps you learn how to correctly complete the ACORD 130 Workers Compensation application.

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ACORD 130 Workers Compensation Application Status of Submission and Billing / Audit Section

The Status of Submission  and Billing/Audit Information section of the ACORD 130 is the second major block from the top of the first page.

STATUS OF SUBMISSION

The Status of Submission has 4 check boxes. These are not mutually exclusive.

QUOTE: Check this if all you are asking for is a quote.

ISSUE POLICY: This is telling your underwriter to go ahead and issue the policy even before they tell you the cost. If you show a policy status of BOUND, you should also check the ISSUE POLICY box.

BOUND: Check this if you have bound the policy. Be certain your agency has binding authority for this line of business with the carrier on whom you are binding the coverage. If you are uncertain, call, email or text your underwriter. Binding a policy means you have legally put coverage in force. Even if the carrier does not give you this authority, the carrier is likely now on this risk and will have to issue notice of cancellation to get off this risk.

ASSIGNED RISK: Notice, if you check this box you also need to complete the ACORD 133 form. States provide Assigned Risk pools to provide workers compensation to businesses insurance carriers do not wish to write on a voluntary basis. Since Workers Compensation laws require businesses with 4 or more employees to carry Workers Compensation insurance, each state provides the Assigned Risk pool as a market of last resort. The price charged to a business insured in the assigned risk pool is higher than the price charged to the same business if they found insurance coverage outside of the assigned risk pool.

BILLING / AUDIT INFORMATION

BILLING PLAN:

The Agency Bill option means your agency is responsible to the carrier for the premiums and your customer is responsible to you for the premium. You will have to issue the invoices and collect the premium. If you cannot collect the premium, depending on your carrier / agency contract, you may just be out this money and receive no help from your carrier.

The Direct Bill option means the carrier bills the customer directly. They are responsible for invoicing and collecting. If the customer does not pay, your agency is not liable for that amount. In fact, you may even still get paid your commission on the policy.

PAYMENT PLAN:

Annual, Semi-annual, Quarterly are all mutually exclusive options. Check to box that applies.

The box with no text beside it is for you to enter any other billing plan. For example, some plans are monthly, some are monthly reporting, etc.

The % Down is asking for you to enter the percentage of the total estimated premium the customer is paying you upon the policy going into effect.

AUDIT:

Workers compensation premiums are based on payroll. Payroll is estimated when the policy is issued or quoted. But the carrier reserves the right to audit the actual payroll and revise the premium.

Check the box for the audit time period the carrier will use for this policy. For smaller policies this will mostly be AT EXPIRATION.

These boxes are mutually exclusive. Check only one.

The check box with no text next to it is for any other audit period not listed by the other check boxes.

I hope this helps you in learning how to complete the ACORD 130 Workers Compensation Application.

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ACORD 130 Workers Compensation App Producer Infomation

Agent Information

Below your Agency's Name and Address, you enter your personal information.

This is for you the agent, producer, sales rep, account executive - whatever your agency calls you. You are the person the underwriter will be contacting to get more information and to return a quote. That is the main purpose of this section.

PRODUCER NAME: The agent to whom this account belongs.

CS REPRESENTATIVE NAME: This might be the same as Producer, in which case leave it blank or use dittos. Or it will be the name of the customer service rep who helps the producer with this account.

OFFICE PHONE: Your direct phone line, or main number if your agency has no individual direct lines.

MOBILE PHONE: The number for your business mobile phone. If you do not have a business mobile phone you should be certain your agency allows you to take business calls, get business emails and business text messages on your personal mobile phone before you give anyone that number.

It is a major cyber liability exposure for your agency to allow you to use a personal mobile device for business communications. If you ever leave your job at the agency, immediately, and without intent, you will have broken a number of privacy laws by having old business communications on your personal mobile device.

FAX: Your agency fax number if for some reason your agency still uses a FAX machine.

E-MAIL ADDRESS: This should be your business email. Follow the logic of using your personal mobile device above and the same applies to personal email addresses. It is a terrible idea for both you and your employer.

CODE: This is your agency code with the specific carrier to whom you are sending this application.

SUB CODE: This means sub-producer code. This is your individual sub producer code with this specific carrier. The reason for entering this is to make paying you commissions easier for your agency.

AGENCY CUSTOMER ID: This is the ID number assigned by some back office system somewhere. Maybe your agency back office system or the carrier back office system. This is probably left blank most of the time.

If you are using Cap Dat ACORD all this information will pre-fill this section from your profile.

I hope this helps you learn a bit more about how to complete the ACORD 130 Workers Compensation Application.

Please share this with anyone it may help.