ACORD 129 (Workers Comp Claims Supplement)
An ACORD supplement form used to report workers compensation claims with injury and employee details.
What It Is
The ACORD 129 is the Workers Compensation Claims supplement that captures detailed information about workplace injuries. It documents the injured employee's name, Social Security number, date of hire, occupation, hourly wage, and date and description of the injury.
The form includes fields for the body part affected, type of injury, cause of injury, and whether the employee has returned to work. It also captures supervisor information, witness details, and whether the injury was reported to OSHA.
The ACORD 129 is typically submitted alongside the state-specific First Report of Injury form, as many states have their own mandated claim filing forms in addition to the carrier's documentation requirements.
Why It Matters for Brokers
Workers compensation claims reporting is governed by strict state deadlines. Late reporting can result in penalties from the state workers compensation board and may be considered a late-notice violation by the carrier. Brokers who facilitate prompt and accurate ACORD 129 completion help clients avoid penalties and ensure injured workers receive timely benefits. This is particularly important for accounts with high employee counts where claims frequency requires an efficient reporting process.
Real-World Example
A warehouse worker injures their back lifting a heavy box on a Monday morning. The employer's HR manager notifies the broker, who completes the ACORD 129 by Tuesday afternoon with the employee's information, the mechanism of injury (lifting 65-lb box from floor level), the affected body part (lower lumbar), and the treating physician's name. The broker submits the ACORD 129 along with the state's First Report of Injury within the state's 10-day reporting window.
Common Mistakes
- 1Not collecting the injured employee's hourly wage, which delays the carrier's calculation of temporary disability benefits.
- 2Filing the ACORD 129 without the corresponding state-mandated First Report of Injury form, which is a separate regulatory requirement.
- 3Failing to document whether the employer has offered modified duty, which affects the duration and cost of the claim.
How brokerageaudit.com Handles This
BrokerageAudit's claims reporting workflow pre-populates the ACORD 129 from employee census data and flags state-specific filing deadlines. The platform tracks which state forms are required in addition to the ACORD 129.