ACORD 130

What the ACORD 130 is for

The ACORD 130 is the application a work comp underwriter rates from. It carries the states the employer operates in, the class codes and payroll behind the premium, the experience modification factor, and which owners and officers are included in or excluded from coverage.

It is unusually consequential for a submission form because most of what it contains is audited later. A payroll figure or a class code that is wrong on the application is not wrong for long: it is corrected at audit, with a bill attached.

What it collects

Described in our own words, block by block. This is a summary of the information the form gathers, not a reproduction of the form itself.

Status and policy information

Proposed term, the states to be listed, and whether the account is new business or a renewal.

Rating information

Class codes by state and location, with estimated annual payroll and the number of employees behind each.

Experience modification

The mod factor, its effective date, and the rating bureau identification number it is issued under.

Individuals included or excluded

Owners, officers, partners and relatives, with the ownership percentage and whether each is covered.

Contractor and subcontractor information

Work sublet, whether certificates are obtained from subcontractors, and the trades involved.

General information and prior carrier history

Safety programme, prior coverage, premium and losses for the number of years the carrier requires.

Check before it leaves the agency

The defects that cause trouble later are nearly always the same handful. Run these before the form goes out.

• Every state where an employee works is listed. An employee working in an unlisted state is the classic uncovered work comp claim.
• Class codes match the work actually performed. A clerical code on a field employee is corrected at audit at the field rate.
• The experience mod is the current published factor with the right effective date, and the bureau identification number is correct.
• Included and excluded owners and officers reflect what the client actually wants, and what the state permits, since the rules on exclusion vary by state.
• Payroll estimates are realistic for the coming year rather than the outgoing one.
• Certificates from subcontractors are genuinely obtainable; uninsured subs are charged as employees at audit.

What the ACORD 130 does not do

• It does not set the experience modification factor. The rating bureau does, and the application reports it.
• It does not decide employment status. The state's test does, and an audit will apply it whatever the application says.

Which edition?

ACORD revises its forms, and the edition date is printed in the bottom-left corner beside the form number. This page deliberately does not name an edition, because a hard-coded one goes stale and a stale edition on a reference page is worse than none. Produce the form from your own management system, which will give you the current version, and read the corner if a carrier or a contract has asked for a specific one.

At renewal

BindCheck reads a bound renewal against the prior policy and reports every form, limit, deductible and endorsement that changed, with each finding cited to the page it came from. That matters for this form because what you put on an ACORD is only correct for as long as the policy behind it is unchanged: a certificate, an evidence form or a schedule of interests prepared from last term's facts is a defect nobody sees until the party relying on it needs it.

Related forms

• Workers comp renewal review checklist