ACORD 130: Workers Compensation Application.

How the form is used.

Reconcile payroll, duties and states.

Preparation guidance from Hedge. Follow the instructions in the accepted form edition and the intended market's requirements.

1. Organize payroll estimates by entity, state and the classifications being proposed, with the period clearly identified.
2. Describe employee duties and officer treatment so classifications and inclusion choices can be reviewed rather than inferred.
3. Reconcile totals with payroll records and explain changes, subcontractor use, prior losses and gaps in coverage.

What a clearer packet looks like.

A business reports office staff and field installers under one payroll total. Break out the duties and estimates for review, explain shared employees and confirm the treatment with the intended market. Do not choose a classification solely because it appears cheaper.

Hypothetical example, not a placement result or a coverage determination.

ACORD 130 vs. applicant information

The workers compensation application adds payroll, duties and state-specific exposure detail. General applicant information on ACORD 125 alone does not describe those exposures.

Facts to prepare.

• Payroll by state and class code
• Employee duties and headcount
• Experience modification information
• Officer inclusion or exclusion
• Prior coverage and currently valued losses

Review before using the form.

• Confirm class codes reflect actual employee duties
• Reconcile payroll totals across entities and locations
• Explain lapses, new ventures, material losses, and subcontractor use

Use ACORD 130 correctly.

Assemble the account-specific packet.

Use the class submission guide to identify the underwriting facts and Hedge forms that may apply, then have Hedge confirm the intended market and route.