ACORD 126 Claims Made and Employee Benefits Section

How to Complete the Claims Made and Employee Benefits Sections of the ACORD 126

CLAIMS MADE SECTION

If you checked the Claims Made box under the Coverages section at the top of this page, you have to answer the questions in this section.

PROPOSED RETROACTIVE DATE: This is the same as the effective date of this policy.

ENTRY DATE INTO UNINTERRUPTED CLAIMS MADE COVERAGE: If this is a new policy, this will be the same as the Proposed Retroactive Date. If this is a renewal policy, this will the the first effective date of the first claims made policy, assuming there have been no lapses of coverage between that date and this policy.

HAS ANY PRODUCT, WORK, ACCIDENT OR LOCATION BEEN EXCLUDED, UNINSURED OR SELF INSURED FROM ANY PREVIOUS COVERAGE? Answer yes or no.

If you answered yes to the above question, enter an explanation either in the space below te question or in the REMARKS section.

WAS TAIL COVERAGE PURCHASED UNDER ANY PREVIOUS POLICY? Answer yes or no.

If the answer is yes, use the space below the question to enter the company name, policy number, effective dates and limits for this coverage.

Once again I lean on IRMI for a good definition...

A provision found within a claims-made policy that permits an insured to report claims that are made against the insured after a policy has expired or been canceled, if the wrongful act that gave rise to the claim took place during the expired/canceled policy.


EMPLOYEE BENEFITS LIABILITY

If your policy will include Employees Benefits Liability coverage you must answer the questions in this section.

DEDUCTIBLE PER CLAIM: Enter the dollar amount of this deductible.

NUMBER OF EMPLOYEES: Enter the total number of employees whether or not they are covered under provided employee benefits.

NUMBER OF EMPLOYEES COVERED BY EMPLOYEE BENEFITS PLANS: Enter the number of employees covered under provided employee benefits. This may be the same or it may be less than the answer to the previous question. It would be strange if it was more.

RETROACTIVE DATE: This will normally be the same as the Retroactive Date listed in the Claims Made section above.


I hope this has helped you learn how to complete the ACORD 126 Claims Made Section and Employee Benefits Liability section.