ACORD 130

Workers' Compensation Application

The workers' comp supplement. Captures state-specific classification codes, payroll by class, experience modification rate, and officer/partner details.

What This Form Is For

The ACORD 130 is the workers' compensation supplement to the 125 master application. Workers' comp has its own distinct rating system — based on NCCI class codes (or state-specific bureau codes), payroll by classification, and the experience modification rate — making this form essential for accurate premium calculation.

This form captures which states the business operates in, employee classifications and corresponding payroll, the experience modification rate (EMR), officer and partner inclusion/exclusion elections, OSHA history, and subcontractor details.

Because workers' comp is state-regulated with rates and rules varying significantly by jurisdiction, multi-state operations need particular attention on the 130. Each state where employees work must be listed, and some states have their own monopolistic funds or unique classification systems.

Section-by-Section Walkthrough

Fields That Matter Most to Underwriters

  • 1NCCI class codes and payroll by classification — the premium calculation foundation
  • 2Experience modification rate (EMR) — the strongest indicator of loss propensity
  • 3States of operation — rate variations can be dramatic between states
  • 4Subcontractor insurance status — uninsured subs add significant exposure
  • 5OSHA citation history — signals safety culture and compliance risk

Common Mistakes

Wrong class codes

NCCI class codes must match actual duties, not job titles. Misclassification leads to incorrect premium and creates audit exposure. The carrier will reclassify at audit and charge the difference with interest.

Misreported payroll

WC premiums are directly tied to payroll. Underreporting reduces the initial premium but results in a larger audit adjustment — the carrier collects the difference plus interest. Overtime should be reported at straight-time rates.

Missing the experience mod

If the business qualifies for an EMR, omitting it means the carrier quotes at manual rates — usually higher than the modded rate for businesses with decent loss histories. Always include the current mod worksheet.

Forgetting subcontractor exposure

Uninsured subcontractors are treated as the hiring business's employees for WC purposes. If certificates aren't collected and verified, the subcontractor payroll gets added at audit — often at the most expensive class code rates.

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