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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