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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