ACORD 855 — Workers Compensation — Section 2
What is ACORD 855?
The ACORD 855 provides supplemental workers compensation information beyond what the ACORD 130 captures. It is used for multi-state operations, United States Longshore and Harbor Workers coverage (USL&H), and additional classification details.
This form is typically required when the insured operates in multiple states or has exposures that require specialized workers compensation endorsements.
When do brokers use ACORD 855?
Used alongside the ACORD 130 when the workers compensation submission involves multi-state operations, maritime exposures, or supplemental classification information that doesn't fit on the primary application.
Key fields explained
Additional State Operations
States beyond the primary state where employees work, with class codes and payroll per state.
USL&H Coverage
United States Longshore and Harbor Workers Act coverage requirements for maritime employees.
Supplemental Classifications
Additional class codes and payroll details for complex operations.
Common mistakes to avoid
Not filing ACORD 855 when employees work in multiple states
Missing USL&H coverage for employees working near navigable waters
Inconsistent class codes between ACORD 130 and ACORD 855
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.orgTrack multi-state workers compensation requirements with BrokerageAudit Compliance Calendar
BrokerageAudit automates ACORD form processing, verification, and tracking — so your team can focus on clients instead of paperwork.