Workers’ Compensation

Please submit the following items in order to obtain a quote:
  1. A completed ACORD Worker’s Compensation application (ACORD 130 or 130FL for Florida) – all sections including prior loss experience and questions.
  2. Prior carrier loss runs for the past 3 years including the expiring year, valued within 90 days prior to the proposed effective date.
  3. 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.
  4. The most current experience modification worksheet or snap shot.
 
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