How to Complete the Acord 130

As you begin a career in insurance, it is critical to develop a familiarity with applications used in the Agency Management System (AMS).  Continue reading for more details on the applications you will be using every day to manage client information.

What Are Acord Forms?

ACORD forms are universally recognized documents that contain information which most, if not all, insurance carriers require be completed in order to provide a quote back to the agency.  There are several Acord forms and each serves a purpose specific to the type of coverage that it represents.  One form you will see frequently is the Acord 130.

What is an Acord 130 Form?

The Acord 130 form is more commonly knowns as the Workers Compensation Application.  This application is used to capture policy information specific to what is needed to rate workers compensation including payroll, loss history and other details regarding business operations. 

You may be looking at this and wondering if you need to know how to fill out accord 130?  The answer is, yes!  This application is used for every workers compensation policy so it is important that you understand how to complete an Acord 130.

Let’s look over a few key points in the form that you will want to make sure you pay attention to when completing the Acord 130.

Page 1 will focus on the basics the company needs to begin the underwriting or rating process. 

The very beginning of the form requires the agency.  The Agency Management System will most likely fill out the agency information, but if completing outside of an AMS, be sure manually enter the required details.

Just to the right of the agency information is a space for the Applicant Information.  In this area of the form you will need to complete the fields for Applicant name, Phone number(s), Years in Business, Mailing address, Applicant Entity type, ID Number (if applicable) an the Federal Employer ID Number (EIN).

Just below the contact information you will find sections for Status of Submission as well as the Billing/Audit Information.  If you are preparing this application to be submitted to the carriers with others you will want to select “quote.” In the area designated for billing you will need to confirm whether the insured or the agency will be billed for the premium as well as what payment plan the client has selected. You will also see a box in this line for Audit which is used to indicate how often a policy will be audited.  

The next area you will find in the Acord 130 is the Locations section.  Here you will need to enter the location number and full address for the insured.   Use additional lines as needed to record all of the insured’s locations.

Once you have completed the Locations section, you will move onto the Policy Information area of the application.   This portion of the form is used to capture the effective and expiration date as well as Part 1  – State (s) in which the insured operates, Part 2 – Employers Liability (this is the amount the applicant will receive in the event of a loss so be sure to choose the appropriate limit) and Part 3 – Other states for any other states insured may need coverage in during the policy period.

After the Policy Information section you will see a spot for Contact Information.  If you fill out the Acord 125 for the same applicant then you do not need to fill out this section. If you are submitting Form 130 without the Acord 125, you must then fill out this section with the applicant’s contact information.

As you work your way through Page 1, the last section you will find is for Individuals Included/Excluded.  This area of the form identifies owners, partners, officers and relatives employed by the business and indicates their status to be covered or not covered under the benefits provided by the Workers Compensation policy.  For all individuals that qualify in one of the roles listed above you will need to enter their name along with State, Location #, Title or Relationship to the insured, Percentage of ownership, included or excluded (inc/exc) and payroll.   

Now that you’ve completed the first page, you’re ready to move onto Page 2 of the application!

The majority of Page 2 is dedicated to the State Rating Worksheet.  In this section you will want to enter what operations occur at each location.  You will need to include: Location #, Class code, Categories, Duties and Classifications, and Number of Full time and Part Time employees at the location.  It is important to note that if the applicant separates their payroll based on the different duties in their company, you will want to create a separate line item for each duty with its respective class codes. This will help you get a lower rate! If you only input one category, it will automatically be grouped under the highest rated class code.

In the Premium section of the application, the primary thing you will want to be concerned with is entering the Experience Mod. The Experience Mod is Number given to the applicant by NCCI based on their loss history.  Must have three years of Workers’ Compensation experience with a premium over $3,000.A good modifier is less than 1.0 and saves the client premium.  A bad modifier is over 1.0 and will cost the insured additional premium.  Not all clients will have an experience mod, but if they do, you will want to be sure to include that number here.   

*Other fields in this section will be generated by the carrier during the quoting process.

Page 3 will get into more detail regarding the applicant’s policy history and business operations.  

The first section on Page 3 is designated for Prior Carrier Information and Loss History.  In this section you will need to enter prior coverage details for the past 5 years including Policy Year, Carrier Name, Policy Number, Premium, Experience Mod (if applicable), number of claims, total amount paid on claims as well as any reserve there may be on any open claims.    

Once you have completed the Prior Carrier Information and Loss History you will arrive at the Nature of Business section of the application.   In the area below, you will want to provide a description of the insured’s operations.  

It is important to note that it is necessary to fill out this section only if you did not fill out ACORD 125 and will be submitting this form independently. 

Next you will find the General Information section which will span both Page 3 and Page 4 of the application.  There is a series of 24 questions in this section which need to be completed by indicating “yes” or “no” in the right-hand column of the page.   You will also need to include an explanation for any “yes” answers.  

The end of page 4 provides spaces for signature from the Producer and Insured.  These will not be required during the quoting process but will need to be obtained when the policy is bound.

Other Important Notes:

An Acord 130 fillable form (as well as other Acord forms) should be available in your Agency Management System.  You can complete the form and then send an Acord 130 PDF to the client to review and sign.   

Some of the details reviewed will pre-fill in your AMS.  This will save you time when completing the Acord 130 form.