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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