Submission Requirements

  • Completed and signed Acord Workers’ Compensation Application
  • Currently valued loss runs (five years preferred)
  • Five-year payroll history
  • Financials
  • Current experience mod worksheet
 
ADDITIONAL INFORMATION WHICH WILL ASSIST IN THE QUOTING PROCESS
  • Details on large claims will be requested. If a deductible is involved, please indicate whether the amounts shown are gross of the deductible ("ground up"), or net of the deductible. We welcome data in an electronic format.
  • If the insured owns, operates or leases aircraft, an Industrial Aid Aircraft application will need to be completed.
  • Please elaborate on any change in operations over the last five years to explain payroll or loss history.
  • Any elaboration on safety program already in place is appreciated.
  • It should be appropriate for size of account and exposures. We will pre-inspect where needed.