Workers Compensation

ACORD Forms and Insurance Applications

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Workers compensation insurance covers the cost of medical care and rehabilitation for workers injured on the job. It also compensates them for lost wages and provides death benefits for their dependents if they are killed in work-related accidents, including terrorist attacks. The workers compensation system is the "exclusive remedy" for on-the-job injuries suffered by employees. As part of the social contract embedded in each state's law, the employee gives up the right to sue the employer for injuries caused by the employer's negligence and in return receives workers compensation benefits regardless of who or what caused the accident, as long as it happened in the workplace as a result of and in the course of workplace activities.

Classes We work with a variety of carriers to provide you with coverage for most classifications
What is Required / Forms New Submissions Requirements:
  • Complete ACORD Applications for Your State
  • Current Valued Loss Runs with a minimum of 3 years (5 years preferred)
If Available:
  • Copy of current policy
  • Expiring premium or target premium
Direction for Submissions Step 1: Print the ACORD form.
Step 2: Complete the ACORD form.
Step 3: Fax the completed ACORD form to 866-884-4796 or scan and email the form to
Insurance Company Rating All Carriers are “A” Rated
Territory All States
Coverage State mandated coverage for work related injuries and medical conditions
Deductibles No Deductible for small accounts.  For accounts with 100+ employees we do offer high deductible programs as wells as SIR (Self Insured Retention) and Captives.
Marketing Material Available  on Request
Premium Financing Yes
ACORD Forms and Insurance Applications

Contact Us for more information about our services!