ACORD 130, Workers Compensation Application
What is ACORD 130?
The ACORD 130 is the supplemental application for workers compensation insurance. It captures employee classification codes, estimated payroll by classification, experience modification rate (EMR), and prior loss history.
Accurate completion is critical because workers compensation premiums are directly calculated from class codes and payroll. Errors in classification or payroll estimates result in significant audit adjustments at policy expiration.
When do brokers use ACORD 130?
Required for every workers compensation submission alongside the ACORD 125. Used for all employers with employees who are required to carry workers compensation coverage (mandatory in most states).
Key fields explained
Class Code Schedule
NCCI or state-specific class codes with estimated annual payroll for each classification.
Experience Modification Rate
The EMR factor applied to manual premium, reflecting the employer's loss history relative to industry average.
Prior Policy Information
Current carrier, policy number, premium, and effective dates for the expiring policy.
Loss History
Workers compensation claims for the past 3-5 years including claim counts, paid amounts, and reserves.
Common mistakes to avoid
Incorrect class code assignment leading to wrong premium calculation
Underestimating payroll resulting in large audit premium at policy end
Not providing accurate experience modification rate
Missing states where employees work (multi-state operations)
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Related ACORD forms
Download the official form
Official ACORD forms are available from ACORD.org. This page explains how to complete the form, visit ACORD for the actual document.
Visit ACORD.orgAuto-generate workers compensation applications from your AMS payroll data
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