Workers’ CompensationPlease submit the following items in order to obtain a quote:
- A completed ACORD Worker’s Compensation application (ACORD 130 or 130FL for Florida) – all sections including prior loss experience and questions.
- Prior carrier loss runs for the past 3 years including the expiring year, valued within 90 days prior to the proposed effective date.
- A detailed description of all claims with a total incurred amount of $25,000 or more. Expected information should include the injured employee’s occupation, what he/she was doing when the injury occurred, and cause of injury.
- The most current experience modification worksheet or snap shot.