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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