How to Complete the ACORD 130: Field-by-Field Guide

FEIN (Federal Employer Identification Number)

What it is asking: The IRS tax identification number for the business entity, in XX-XXXXXXX format.

Why the underwriter needs it: The FEIN is used to pull the NCCI experience rating worksheet, verify the experience modification factor, and cross-reference the employer's claims history across carriers. Without the correct FEIN, the underwriter cannot verify the X-Mod or look up loss history.

Tip: The FEIN must match the entity that appears on the NCCI experience rating worksheet. If a business recently changed entity type (sole proprietor to LLC, for example) and got a new FEIN, the experience rating may not transfer automatically. Ask the client's payroll provider what FEIN is on record with NCCI.

Entity Type

What it is asking: The legal structure of the employer — sole proprietor, partnership, LLC, corporation, etc.

Why the underwriter needs it: Entity type determines the rules for officer inclusion and exclusion, which directly affects payroll and premium. The rules vary significantly by state and entity type — corporate officers can often exclude themselves, but sole proprietors are automatically excluded in most states.

Tip: Look up the exact entity type in the state's Secretary of State database before entering it. A client who says "I have an LLC" may actually be incorporated as a corporation — and the officer exclusion rules are different for each entity type.

Primary State of Operations

What it is asking: The state where the majority of the employer's workers are based and where most work is performed.

Why the underwriter needs it: Workers comp is regulated at the state level. Each state has its own benefit schedule, rate tables, and eligibility rules. The primary state determines which state's rate manual applies and which carrier forms are used. WC policies are state-specific by design.

Tip: If the business is headquartered in one state but the majority of employees work in another (e.g., a Texas-based company with most workers in Louisiana), the primary state should reflect where the most payroll is generated, not where the company is registered.

Other States — All States Endorsement

What it is asking: Whether employees work in states other than the primary state — whether regularly or occasionally for projects.

Why the underwriter needs it: If an employee is injured while working in a state not listed on the policy, there is no coverage under that state's workers comp statute. This creates serious legal and financial exposure for the employer.

How to handle it: List every state where employees work, even temporarily. Most WC policies include an "Other States" endorsement (Coverage Part C) that extends protection to unlisted states — but only for employees who are regularly based in a listed state and temporarily working in another.

Tip: For contractors or service businesses that travel frequently for work, request a broad Other States endorsement that includes all states except monopolistic states (ND, OH, WA, WY) which require their own state-fund policies. This is a common coverage gap for multi-state employers.

Do Employees Travel Out of State?

What it is asking: A yes/no question about whether any of the insured's employees regularly or occasionally perform work in states other than the primary state.

Why the underwriter needs it: Out-of-state travel triggers multi-state coverage requirements and may require the carrier to be licensed in additional states. Some WC carriers have limited state filings — if the carrier is not licensed in a state where an employee is injured, there can be a coverage problem.

Tip: Even if employees travel out of state for only a few days per year (a maintenance crew that drives to a job in the next state, for example), answer Yes and list the states. The additional premium for multi-state coverage is typically minimal compared to the risk of an uncovered claim.

Classification Code (NCCI Code)

What it is asking: The 4-digit NCCI (National Council on Compensation Insurance) classification code that describes the type of work each group of employees performs. Each code has an associated rate per $100 of payroll.

Why the underwriter needs it: Classification codes are the foundation of WC rating. A plumber is rated at a very different rate than an office employee — sometimes 50x more per $100 of payroll. Using the wrong code results in a quote that will be corrected at audit, often resulting in a significant additional premium charge.

Common codes and their uses:

• 8810 — Clerical office employees
• 8742 — Outside salesperson
• 5190 — Electrical wiring
• 5183 — Plumbing
• 5645 — Residential carpentry
• 3632 — Machine shop
• 7380 — Drivers / chauffeurs

Tip: When in doubt about the correct code, describe what the employee does in detail and let the underwriter assign the code. Using a lower-rated code to reduce premium is a form of misrepresentation and will be corrected at audit with back-premium owed — plus it creates E&O exposure for the agent.

Estimated Annual Payroll by Classification

What it is asking: The total estimated annual wages (W-2 payroll only — not 1099 payments) for all employees within each classification code.

Why the underwriter needs it: Payroll is the exposure base for WC rating. Premium = (Payroll ÷ 100) × Rate. The estimated payroll at policy inception is used to calculate the deposit premium. At the end of the policy year, the carrier audits actual payroll and adjusts premium accordingly.

What to include in payroll: Gross wages including overtime, bonuses, commissions, and vacation pay. Do not include tips reported directly by employees (in some states), employer contributions to group health or retirement plans, or payments to independent contractors (with caveats — see below).

Tip: If the business uses 1099 contractors who perform the same work as employees (this is common in construction), the carrier may reclassify them as employees at audit. Ask your client to provide their actual payroll records from their payroll provider, broken down by job type — do not rely on their verbal estimate of "about $500K in payroll."

Officer / Owner Information — Names, Titles, Ownership %

What it is asking: The full name, title, and ownership percentage of every officer or partner. For LLCs, this means all members; for corporations, all officers; for partnerships, all partners.

Why the underwriter needs it: Officers and partners have special status under WC law. Their inclusion or exclusion from coverage changes the total payroll used for rating and their personal coverage status if they are injured on the job.

Tip: Many states have minimum and maximum payroll amounts for included officers regardless of their actual wages. For example, in Texas, an included officer's payroll for WC rating purposes may be capped at a state-determined maximum even if they earn more. Ask your underwriter about the applicable minimums and maximums for your state before entering officer payroll amounts.

Officer Inclusion / Exclusion Election

What it is asking: For each officer or partner, whether they elect to be included in or excluded from workers compensation coverage.

Why the underwriter needs it: Including or excluding officers changes the rated payroll and the personal protection the officer receives. Excluded officers are not covered if they are injured while working — a fact that should be explained clearly to clients before they elect exclusion.

State-specific rules (examples): Texas — WC is completely optional for private employers. California — S-Corp officers may exclude themselves; sole proprietors and partners are automatically excluded and must elect inclusion. Florida — Officers of construction corporations cannot exclude themselves.

Tip: Have clients sign a written acknowledgment of their exclusion election — especially in states where the rules are complex. An officer who excludes themselves from WC and then gets injured on the job will look to their health insurance for coverage (which may exclude work-related injuries) and potentially to you for an E&O claim if they did not understand what they were signing.

Experience Modification Rate (EMR / X-Mod)

What it is asking: The employer's current experience modification factor, as calculated by NCCI (or the applicable state rating bureau). An X-Mod of 1.00 is average. Below 1.00 is better than average (premium discount). Above 1.00 is worse than average (premium surcharge).

Why the underwriter needs it: The X-Mod is the single most important factor in WC premium calculation. An employer with a 0.75 X-Mod pays 25% less than average. An employer with a 1.35 X-Mod pays 35% more than average. The underwriter verifies the X-Mod against the NCCI database.

How to get it: The X-Mod appears on the current WC policy declarations page. It can also be found on the NCCI Experience Rating Worksheet, which the current carrier should provide. First-time buyers (under 3 years in business with no qualifying payroll threshold met) will not have an X-Mod — enter 1.00 or N/A.

Tip: If the client's X-Mod is above 1.20, be prepared for some carriers to decline or surcharge significantly. In this case, include loss run detail and a narrative about corrective actions taken (new safety programs, termination of high-risk workers, improved claims management) — this context can move the needle with some carriers.

Prior WC Carrier Name, Policy Number, and Expiration

What it is asking: The name of the current or most recent WC carrier, the policy number, and the policy expiration date.

Why the underwriter needs it: Used to verify the X-Mod, request loss runs, and check for mid-term cancellations or non-renewals. A carrier that sees a client who was cancelled mid-term by their prior carrier — especially for non-payment or safety violations — will scrutinize the application heavily.

Tip: If the client was non-renewed for claims or cancelled for any reason other than non-payment, disclose it upfront with an explanation. Carriers will discover it when they pull the NCCI claims database — finding out after submission is far more damaging to the relationship than proactive disclosure.

Loss History — Five Years of WC Claims Detail

What it is asking: All workers compensation claims filed in the past 5 years. For each claim: date of injury, type of injury, employee job title, amount paid to date, amount still reserved, and current claim status (open or closed).

Why the underwriter needs it: WC loss history is the most predictive factor for future claims. Underwriters look at both frequency (how many claims) and severity (how large each claim was). A pattern of frequent small claims is often more concerning than a single large claim, because it suggests a systemic safety problem rather than an isolated incident.

Open reserves matter: Outstanding reserves (money set aside for future claim payments that have not yet been paid) count against the insured just as much as actual payments. A claim with $0 paid and $200,000 reserved is still a $200,000 exposure to a new carrier.

Tip: Always obtain actual loss runs from the prior carrier before completing this section. Do not rely on the client's recollection of their claims history — clients routinely forget claims, underestimate severity, or confuse GL claims with WC claims. Discrepancies between the application and the loss runs are a red flag for underwriters.

USL&H / Longshore and Harbor Workers Compensation Act Exposure

What it is asking: Whether any employees work on or near navigable waters, docks, wharves, piers, or terminals — exposures covered under the federal Longshore and Harbor Workers' Compensation Act (LHWCA or USL&H) rather than the state WC statute.

Why the underwriter needs it: USL&H coverage is provided under a separate federal act with different benefit schedules and significantly higher potential claim costs than state WC. Employees who load and unload ships, repair vessels, or work at marine terminals are subject to USL&H, not state WC. This exposure must be disclosed and is often rated separately.

Tip: This question trips up agents who work with maritime adjacent industries — construction companies that work on port facilities, logistics companies near waterways, and repair shops on waterfront properties. If your client does any work within 300 feet of navigable water, investigate whether USL&H applies before answering No.

Maritime / Jones Act Exposure

What it is asking: Whether any employees are considered "seamen" who work aboard vessels — covered under the Jones Act (Merchant Marine Act of 1920) rather than state WC or USL&H.

Why the underwriter needs it: Jones Act coverage is a separate line from WC with much higher potential liability (seamen can sue for negligence under the Jones Act, which standard WC does not allow). This exposure requires specialized coverage that most standard WC carriers do not provide.

Tip: If your client has any employees who work primarily on a vessel that is "in navigation," consult a marine insurance specialist. Standard WC markets generally exclude this exposure — trying to cover it under a standard WC policy will result in a coverage gap at claim time.

Written Safety Program

What it is asking: Whether the employer has a formal, written workplace safety program. Many carriers ask for additional detail: when it was last updated, whether employees are trained annually, and whether the program is tailored to the business's specific hazards.

Why the underwriter needs it: A documented safety program is one of the strongest signals of a well-managed risk. Employers with formal safety programs have statistically lower injury rates and better claims outcomes. Some carriers offer schedule credits (premium discounts) specifically for documented safety programs.

Tip: If your client does not have a written safety program, help them create a simple one before submitting. A basic written safety policy (emergency procedures, reporting requirements, PPE standards) takes a few hours to create and can result in 5–15% premium savings on a large WC account.

Drug-Free Workplace Program

What it is asking: Whether the employer has a formal drug-free workplace policy including pre-employment screening, random testing, and post-incident testing.

Why the underwriter needs it: Drug and alcohol involvement is a significant factor in workplace injuries. Many states offer WC premium discounts (5–7.5% in some states) for employers with certified drug-free workplace programs. Post-incident testing can also reduce claim costs when it demonstrates employee fault.

Tip: Check your state's drug-free workplace premium credit program. In Florida, Georgia, Texas, and many other states, a certified DFWP can reduce WC premiums by a meaningful percentage. The annual credit typically exceeds the cost of maintaining the program.