How to Submit ACORD 130

Your step-by-step guide to completing the ACORD 130 (Workers’ Compensation)

What Is the ACORD 130?

The ACORD 130 is the standardized application for Workers’ Compensation and Employer’s Liability. It captures everything from applicant details, payroll, classification codes, to loss history and audit information. Accurate completion is critical for underwriting, rating, and binding. 

Step 1: Identification & Agency Information (Page 1)

Begin at the top of the form:

• Date of application
• Agency name, code, phone, fax, email
• Insurer/Company name (if known)
• Applicant name (First Named Insured)
• FEIN/Employer ID, years in business, website, and entity type
  
  

💡Tip: Consistency between the ACORD 125 and ACORD 130 matters—use the exact same “Named Insured” wording to avoid processing errors.

Step 2: Submission Details, Billing / Audit Info & Locations (Page 1)

Next, complete these blocks:

• Status of Submission: Quote, Bound, Issued, etc.
• Billing / Audit Information: who is billed, payment plan (annual, semi‐annual, quarterly)
• Locations Section: List each location number, address, and whether work is performed off‐site
  
  

🗂️ Pro Tip: If work from home or job‐site operations exist, ensure you’ve listed all states and locations—multi‐state operations often trigger separate filings.

Step 3: Policy Information (Page 1)

Fill in:

• Proposed Effective and Expiration Dates
• States applicable (all states where operations occur)
• Employer’s Liability Limits (Each Accident, Disease – Each Employee, Disease – Policy Limit)
• Voluntary Compensation / Foreign Liability if applicable
  
  

📌Tip: Validate whether the form is “Occurrence” or “Assigned Risk” and mark the correct box; make sure you’ve connected exposures in all states where payroll occurs.

Step 4: Contact & Individuals Included/Excluded (Page 1)

Record:

• Contact person info (phone, mobile, email)
• List all owners/officers and mark whether they are included in the policy or specifically excluded
• Provide ownership percentage, state of residence, title
  
  

🧠 Why it matters: Properly including/excluding officers affects both underwriting eligibility and premium calculation—especially in states where officer exclusion is permitted.

Step 5: Class Codes, Payroll & Estimated Annual Premium (Page 2)

On Page 2 you’ll see the breakdown:

• Class Code (NCCI or state code)
• Description of operations
• Estimated annual payroll per class
• Number of employees (full-time, part-time, seasonal)
• Basis of premium (e.g., per $100 of payroll)
  
  

💡Tip: Underestimating payroll can result in significant audit adjustments later. Use realistic numbers or last year’s audit worksheet.

Step 6: Prior Coverage & Loss History (Page 2)

Enter:

• Prior 5 years of carriers, policy numbers, premiums, experience mods
• Total incurred losses (paid + reserved)
• Number of claims and large claim explanations
  
  

📈Tip: Attach a loss run if possible. A clean loss history improves underwriting confidence, controls MOD, and often drives better pricing.

Step 7: Safety Programs & General Information Questions (Page 3)

On Page 3 you’ll complete a series of yes/no questions covering:

• Formal safety or loss control programs
• Return‐to‐work, drug testing, experience mod under 1.0
• Seasonal operations, leased employees, subcontractors
• Other exposures, e.g., offshore operations, employee leasing
  
  

If you answer “Yes” to any question, explain the exposure in the Remarks section.

Step 8: Signatures, Attachments & Submission (End of Form)

Finish by having both the applicant (insured) and the producer (agent) sign & date the form.
Ensure all required attachments are included:

• Loss runs
• Experience modification worksheet
• Schedule of operations if needed
• ACORD 125 (if used)
  
  

💡Final Agent Tip: Think of the ACORD 130 as your client’s operational DNA—it connects payroll, employee exposure, class codes, and safety history. A well-completed form helps underwriters move quickly—and helps your client get accurate quotes faster.

📝How to upload your ACORD form on Semsee

Semsee is only able to accept ACORD forms 125, 126, 130, 140, and 160.

We’re unable to accept handwritten documents or files over 10MB. If the file includes any other forms or documents outside of the approved ACORDs, the upload will fail. Before submitting your form, make sure that you type in your information into the ACORD. 

💡Final Agent Tip: Before you submit the ACORD form you must remove the instructional pages attached to the form. Try reprinting the form as a PDF, and customize the pages you want to save. Also, do not add an Endorsement page.