Tips for Completing Assigned Risk Applications

Posted Date: Current

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Binder issuance for your clients and commission payments to your agency may be delayed or cancelled when incomplete ACORD® 130 and 133 applications are submitted. Please pay special attention to these requirements:
  • The threshold information as described in the Assigned Risk SupplementSupplement 4.C.

Producer Information

  • Agency and producer license numbers must be included.

Employer Information

  • A Federal Employer Identification Number (FEIN) for each commonly managed entity requesting coverage under the application must be provided.
  • Complete physical locations, business mailing address, producer section, policy limits, legal status, Part 1 state, and number of employees by location, and payroll.
  • Give a complete description of all operations and the applicable class code. Add all class codes that pertain to any subcontractors, e.g., Construction, Trucking, Farming, etc. Codes may be listed on an "if-any" basis.
  • Correct corporate titles, ownership percentage, and the corresponding class codes are necessary, even if coverage is excluded.
  • The number of declinations of coverage obtained in the voluntary market must be listed on the application.
  • Check the NCCI Workers Compensation Insurance Plan State Instructions Page to verify the amount of down payment required.


  • When corporations apply for coverage, only an officer who is entered in the Inclusion/Exclusion section of the ACORD® 130 application may sign the application.
  • The ACORD® 130 and 133 applications must be signed by both the employer and the producer.

Election/Rejection Forms

When applicable, the appropriate state-specific election/rejection documents should be sent with the signed ACORD® 130 application to avoid possible additional premium.

Note: Confirmation of coverage is possible within 24–48 hours, if all information is provided.