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

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ACORD 130 Agent Information

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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 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 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 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 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.

We all learn things for the first time at some point. Please share this as often as you wish.

ACORD 130 Workers Compensation Application Applicant and Carrier Information

Part 3 How to Complete a Workers Compensation Application

The Carrier and Applicant information is in the top right hand corner of page 1 of the ACORD 130.

Carrier Info

COMPANY NAME: This is the name of the specific insurance carrier to whom you are sending the application.

UNDERWRITER: This is the name of the actual underwriter at the carrier to whom you are sending the application. You may not know this person's name.

Applicant Information

APPLICANT NAME: The full legal name of your customer as you need to have it show on the issued policy. Remember, this is how the name will appear on certificates of insurance and driver ID cards.

OFFICE PHONE: The main phone number for your customer's business.

MOBILE PHONE: If you have the person's permission, this would be the mobile phone number that the carrier's inspection staff could use to call your customer. Be certain you have your customer's permission.

MAILING ADDRESS: Post Office Box or street address in full. Includes the city, state and zip code. Normally you would fill this box in the so it looks just like you want it to look on an envelop. Example:

Atlatl, Inc.
P.O. Box 2936
Durham, NC 27715-2936

YRS IN BUS: In plain English this means years in business. You can put a hard number here or you can put the year the business opened. Then you do not have to change it every year at renewal. Example:

4 years 3 months

or,

Since March 2003

SIC: This stands for Standard Industrial Classifications. This is a system created by the U. S. government in 1937 for classifying industries. It was created in response to the problem of economists trying to compile data as a result of the Great Depression and realizing they had nothing much with which to work.

You can find SIC codes at sites such as...

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

or

http://www.naics.com/search/

NAICS: This is the North American Industry Classification System. you can find these numbers at the link above or at...

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


WEBSITE ADDRESS: The main website for your customer's business. If the business has more than one website, say a website for each product the company offers, you will want to indicate this in the remarks section later in the application.

EMAIL ADDRESS: This would be the email address at the business for the person working with you on the workers compensation application.

LEGAL ENTITY TYPE: Check the type of legal entity your customer uses. You will only check one type as these are mutually exclusive. If you are not certain, ask your customer.

CREDIT BUREAU NAME: I have actually never seen this filled in. This is the name of the specific credit bureau from whom the underwriter may choose to get a report. I have no idea how you would know this information.

ID NUMBER: This would be the ID number for this customer, but it is unclear whose ID number this would be - the carriers, your agency's, the credit bureaus? I would leave this blank.

FEDERAL EMPLOYER ID NUMBER: This is the Federal Tax ID number. It is in this format - 12-3456789. Ask your customer for this. They will have it.

NCCI RISK ID NUMBER: The National Council on Compensation Insurance number. If your customer is large enough to have a Workers Compensation experience rating modification, they will also have an NCCI number. This will mean they have had insurance for workers compensation. The number will be on their past policy.

If this is a new business, they will not have this number. Ask your underwriter about this. Let them help you with this input.

OTHER RATING BUREAU ID OR STATE EMPLOYER REGISTRATION NUMBER:  Some states have their own ID numbers. Ask your underwriter for help. She will be vary familiar with the state by state issues for the states she underwrites.

That is a lot. You will not always fill out every single box with a response. Ask other agents in your office or your underwriter what information they need.

I hope this is helpful in teaching you how to complete the ACORD 130 Workers Compensation Application. Please share it with others.

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.

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ACORD 130 Workers Compensation Application - How to Complete the ACORD 130

The first section is so short, let's do two today.

DATE OF APPLICATION

This is the easy one. This is the date you are finished with the app and sending it to your underwriter.

AGENCY NAME AND ADDRESS

This is your agency name, agency address for mailing purposes.

In Cap Dat ACORD this information is auto-filled from your agency profile.

So I guess both are easy.

We all learn things the first time at some point. I hope these short tutorials help you and your fellow workers become better at your job and profession.