ACORD Forms
How to Complete an ACORD 130 Workers Compensation Form
The ACORD 130 Workers Compensation application is the required form for all standard WC submissions. Getting it right matters beyond the submission — errors in class codes, payroll allocation, and officer elections create audit surprises, retroactive premium adjustments, and coverage gaps. Here is how to complete it correctly.
The most important fields on the ACORD 130
WC Class Codes and Annual Payroll
The core of the ACORD 130. Each employee job function must be matched to its NCCI class code, and annual payroll for each class code must be entered separately. This is not total payroll — it is payroll allocated by class code. A business with office staff (8810), installation technicians (5537), and drivers (7380) has three separate payroll entries. Underwriters cannot rate WC from total payroll alone.
Experience Modification Rate (EMR)
The EMR or "mod" from NCCI is the multiplier applied to the manual WC premium. EMR above 1.0 means the insured pays more than standard; below 1.0 means a credit. The EMR must be obtained from the current policy, the state rating bureau, or the prior carrier. Do not leave this blank or estimate it — an incorrect EMR produces an incorrectly priced quote.
Officers/Partners/Members
State law varies on whether corporate officers, LLC members, and partners are automatically included in WC coverage and whether they can elect to exclude themselves. The ACORD 130 has a section for listing each officer, their title, their ownership percentage, their payroll, and their inclusion/exclusion election. Each state has different rules on minimum and maximum officer payrolls. This section must be completed accurately for every officer.
States of Operation
WC is state-regulated — each state where employees work must be listed on the ACORD 130, and the WC policy must include coverage for all states. A business with employees in Texas (a non-compulsory state) and California has different requirements than one operating only in a single state.
Number of Employees
Total headcount by job function, distinguishing full-time from part-time. Part-time employees are included in WC payroll calculations (actual wages, not full-time equivalent). Seasonal employees must be noted — some carriers rate seasonal payroll differently for certain class codes.
WC class code assignment — the most consequential decision
WC class codes have dramatically different rates. Code 8810 (clerical office) might have a rate of $0.18 per $100 of payroll. Code 5190 (electrical wiring) might have a rate of $3.50 per $100 of payroll. Assigning the wrong class code can produce a quote that is dramatically incorrect — and a WC audit that moves payroll from the wrong code to the right code creates a large retroactive premium. Tips for accurate class code assignment:
→Use the NCCI Scopes Manual to look up the correct code for each job function — do not guess from the title
→When an employee does multiple types of work, assign payroll to the highest-rated code that applies to their duties (the "governing class" rule)
→Clerical employees who work only in an office are always 8810 — but only if they have no field exposure and do not drive for work
→Drivers whose primary function is driving are typically 7380 (delivery) or similar auto-specific codes — not the code for the trade they deliver for
→Executive officers in a business where manual work is performed cannot always use 8810 — their code follows the operations they oversee if they participate in manual work
Common ACORD 130 errors that cause problems
✕Entering total company payroll in a single class code instead of allocating by job function
✕Not completing the officer section — leaving officers unaddressed creates inclusion/exclusion ambiguity
✕Using estimated payroll that is significantly lower than actual payroll — WC audits recover the difference plus administrative costs
✕Not listing all states where employees work — an employee working in an unlisted state may not have WC coverage
✕Confusing gross payroll with net payroll — WC is rated on gross wages, including overtime (at straight-time rate for most states)
Generate a completed ACORD 130 from client intake automatically
AgencyAssist captures payroll by job function, class codes, officer elections, states of operation, and EMR during intake and populates the ACORD 130 automatically.